Obesity on the Rise – Some Solutions?

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The Obesity/Diabesity Pandemic

Obesity is a major risk factor for the development of  type 2 diabetes mellitus, so much so that the epidemic is often called diabesity. It has been described as one of the most important crises that has invaded our public health system.

Global Statistics,  Source: Lancet

  • Since 1980, the number of adults with diabetes worldwide has quadrupled from 108 million to 422 million in 2014.
  • Diabetes is fast becoming a major problem in low and middle-income countries.
  • From 1980 to 2014, the prevalence of diabetes more than doubles for men in India and China.
  • Half of adults worldwide with diabetes in 2014 lived in five countries: China, India, USA, Brazil and Indonesia.

So what are some solutions?  

The standard American diet is in much need of an overhaul and our national food systems need to change if we wish to reverse or at least slow down this trend. Many say that it would take the same determination as the campaigns to change behaviors that were utilized during the campaigns against smoking. .

Prevention awareness should be first on the front lines of treating the people with prediabetes that can often be reversible using lifestyle modifications. There are already some prevention models in the community; however, these should be expanded so that they become more easily accessible to more people. The Diabetes Prevention Program (DPP) uses intensive behavioral therapy to help people lose a little bit of weight (typically 5-10%). When this program is followed, the number of people progressing to have diabetes comes down by more than half. In people over 60, the reduction was 70%.

Nutrition education should be incorporated into the school system in the early years to help young children understand the importance of knowing where our food comes from and why nutritious foods are the best choice. They can be taught about balanced eating, calories, reading labels and grocery shopping. Nutrition education can also be offered at the middle and high schools levels by returning to a revamped and modernized home economics course in the curriculum. 

A lingering problem has existed for many primary care physicians for many years in that they say they were never adequately prepared in nutrition principles in medical schools. In a survey of family physicians (2009), two thirds said that dealing with extremely obese patients is “frustrating “and one-half said treatments are often ineffective. This is reflected by a lack off obesity training.

Shockingly, another survey in 2010 of 140 doctors revealed that nearly one-third were not even familiar with the American Diabetes Association (ADA) prediabetes guidelines. Only 6 percent were able to identify all 11 risk factors and on average, the doctors could only identify just eight of the warning signs. Only 17 percent knew the correct laboratory values for blood glucose and only 11 percent said they would refer a patient to a behavioral weight loss program..

There should be an increased access to professional treatments.  Physicians in reality do not have the time to directly counsel their patients on the myriad of diets designed for healthy weights. Medical professionals not trained in obesity management should refer their patients to outside providers such as dietitians, exercise trainers, behavior therapists, psychologists, or a new concept of health coaches. These providers should be trained, certified, and credentialed to protect the public from unscrupulous treatments and to provide quality care. Reimbursement of qualified health professionals needs to be enhanced to keep out of pocket expenses reasonable for patients.

However, doctors can act as “cheerleaders” and in a  support role encourage their patients to practice lifestyle behaviors (diet included) that can overall prevent the onset of chronic diseases that make up the leading causes of death. This new paradigm of medical practice has abeen recently called “lifestyle medicine”.

We have become a nation of non-cooks and prefer to have our meals prepared by someone else. Encourage home cooking and home kit meals to help to counter using fast foods and packaged highly processed meals loaded with calories, fat, sugar and salt.

Educate the public on food labeling including ingredient lists. Beware of food companies that promote products with a “health halo” meaning exaggerated claims are made that appear to make unhealthy foods seem healthy because of an added nutrient or ingredient. Corporations also mislead consumers with their labeling so they include four different types of sugar to keep sugar from being listed as the first ingredient. This is misleading to the consumer when attempting to make wise food choices.

Stop corporate-government partnerships and diminish lobbying.
The Academy of Nutrition and Dietetics (formerly the American Dietetic Association) is funded by a myriad of food companies such as Coca-Cola, PepsiCo and Kellogg’s. The dairy industry has a long history of influencing the food pyramid and Dietary Guidelines. A good example is the placing of a glass of milk on the MyPlate Logo.

Another health organization guilty of taking in millions from food companies is the American Heart Association. They offer a “Heart – Check logo for a price: $5, 490 to $7,500 that is renewable for another fee annually. The product has to be low in fat, saturated fat and cholesterol to gain this “honor.” However, some products such as Boar’s Head processed meats have the logo and still may still contain high levels of sodium. If the AHA were sincere in their efforts to help consumers choose healthier foods to rein in obesity/diabetes, they would realize that research has shown that a 1.8 oz. daily serving of processed meat raised the risk of diabetes by 19 percent and heart disease by 42 percent. Most current dietary recommendations emphasize a reduction in processed meats (my emphasis).

There is bad news on rising obesity rates – read about them HERE.

It will take a concerted effort from government, politics, industry, communities,consumers and the perpetrators of our obesigenic culture to begin to change this trend.

 

Is Vitamin C a Valid Treatment for COVID19?

Just read an extensive article concerning the claims that intravenous vitamin C  therapy could be a valid treatment for COVID19. This therapy has been around for decades or at least since the 1970’s when the Nobel Prize winner, Linus Pauling promoted its oral use for curing or preventing the common cold and even as a cancer treatment. Proponents have once again emerged with the same claims concerning COVID19 virus treatment and/or cure with Intravenous vitamin C.

Bottom Line: There is no evidence that this occurs. According to one physician of Orthomolecular Medicine: “if you test people with pneumonia, Influenza or COVID19, you can measure and see that their vitamin C levels are low”; this tells us little if nothing.

Orthomolecular medicine promotes the premise that extremely high doses of natural substances help the body to address illness. For example, the Daily Value for vitamin C is only 90 mg/day (more than enough to prevent scurvy).  In orthomolecular medicine, at least 1500 mg/day would be required and more is better. Fortunately, vitamin C is a water-soluble vitamin and is commonly excreted from the body in urine. However, there are side effects at high doses that include diarrhea and other gastrointestinal issues.

A clinical trial in China is investigating the claim of intravenous vitamin C therapy and COVID19;  and it will be interesting if we hear any positive results when the study concludes next year.

Here are the facts as we know them.

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Intermittent Fasting: Help or Harm?

Intermittent Fasting: Is It Helpful or Harmful?

 

Intermittent fasting simply means that you don’t eat for a period of time each day or week. Some popular approaches include:

Alternate-day fasting. Eat a normal diet one day and either completely fast or have one small meal (less than 500 calories) the next day.

5:2 fasting: Eat a normal diet five days a week and fast two days a week.

Daily time-restricted fasting. Eat normally but only within an eight-hour window each day. For example, skip breakfast but eat lunch around noon and dinner by 8 p.m.

Some research suggests that intermittent fasting may be more beneficial than other diets for reducing inflammation itself, and improving conditions associated with inflammation such as Alzheimer’s disease, arthritis, asthma, multiple sclerosis, and stroke. Studies with a number of animal species have reported that fasting (or calorie restriction) leads to a longer and healthier lives.

There is a lot of confusing advice about whether intermittent fasting is a healthy eating pattern. The following article presents a common sense approach.

One thing is becoming certain. We eat too much and finding safe and healthy ways to combat this trend would seem practical in our society with its concomitant problem of the obesity/diabesity epidemics.

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What the Heck is the Microbiome?

 

What the Heck is the Microbiome?

Much attention has been spent lately describing the health contributions of the microbiome defined as “non-human cells that outnumber human cells and consists of our microbe residents in the human gut, skin, eyes and nasal passages.” These bacterial cells collectively can weigh as much as six pounds.

Another term for the microbiome is the microbiota.  The composition of the microbiota plays an important role during pregnancy and in early life and may affect our metabolic and immune functions later in life. The gut microbiota helps our digestive system efficiency, improves nutrient availability and absorption, and limits the presence of pathogens through competition for nutrients and space.

From the moment of birth, the newborn is exposed to microorganisms obtained from the birth canal of the mother or by exposure to the mother’s skin during a C-section delivery. This colonization is influenced by many factors such as genetics, breast-feeding or formula feeding and weaning to solid food as well as the presence of antibiotic therapy. It is thought that by 2 years of age, the young infant will have established its own stable microbiota. Recently stress and the mother’s diet during late pregnancy may play a role in this initial colonization of the young child.

From studies, it was shown that differences in the gut microbiome during the first year of life may later lead to the onset of obesity. In one study, the numbers of Bifidobacterium species (considered beneficial) were higher and the numbers of Staphylococcus aureus (potentially pathogenic) were lower in children who maintained a normal weight than in children who became overweight at 4 years of age suggesting this pattern may be protective against obesity. In other studies, it was observed that there is a link between the composition of the microbiome during pregnancy and body weight. More specifically, the presence of Staphylococcus and E. coli numbers were higher in women with excessive weight gain during pregnancy. Fecal transplant of an obese microbiome to germ-free mice resulted in a greater increase in total body fat than did colonization with a “lean microbiome” suggesting that the change in the intestinal microbiome environment can promote obesity and other metabolic diseases later in life.

How can we control the content of the microbiome? Guess what – eating more fruits and vegetables have a prebiotic effect on the microbiome.  Prebiotics are nondigestible carbohydrates that reach the colon intact and are known to help the growth and activity of healthy (friendly) bacteria in the gut like Bifidobacterium species.

Increase your intake of unpasteurized fermented foods like fermented dairy products such as yogurt or kefir that contain probiotics. Probiotics are defined as live microbes that offer a health benefit to humans. Bifidobacteria and Lactobacillus species are the most common bacteria groups used.

Probiotics are found in foods such as yogurt, while prebiotics are found in whole grains, bananas, onions, garlic, honey and artichoke. In addition, probiotics and prebiotics are added to some foods and available as dietary supplements. So simply, the prebiotic foods help feed the probiotics.

Use more herbs such as garlic and leeks which contain the prebiotic inulin. Inulin is  a fermentable carbohydrate that is found in some fiber or protein bars. Inulin can cause digestive trouble or aggravate irritable bowel syndrome for some people as there is a threshold of tolerance for their intake. Look on ingredient labels for inulin or chickory root extract.

The study of the microbiome continues to fascinate scientists and its presence may be more involved in our health than previously thought.  But the research is still in its infancy and caution should be stressed so that people do not rush to buy probiotics or attempt self-treatment.  The transplants are experimental and should only be performed by professionals.  A limited number of studies have shown it to be an effective treatment for patients suffering from Clostridium difficile infection (CDI). CDI is a serious and difficult to treat infection causing inflammation of the lining of the abdomen; it is mostly found in  hospitalized elderly patients after excessive use of antibiotics but can affect an estimated 3% of healthy people.

 

Tea Time – Green or Black?

Tea Time – Green or Black?

First, a little background.  Tea is currently the most consumed beverage in the world besides water.  Americans consume an average of 153 cups a year. Most Americans drink black tea while green tea is becoming more popular as claims are made about its health benefits.  more than likely from phytochemicals called polyphenols, specifically catechins and flavonoids. Phytochemicals are substances that have been proposed to have health benefits over and above what the vitamins or minerals provide.  Phyto is the Greek word for plants. Phytochemicals often have strange names (hard to pronounce, so bear with me.)

The active phytochemical in teas is called epigallocatechin -3 galate (EGCG) found in green tea.   Green tea is produced from the withered leaves and buds of Cameillia sinensis by heating or steaming before drying.

Bottled tea is not equivalent to brewed tea in terms of polyphenol content.  While all teas (not herbal) contain between 100-300 mg of flavonoids per serving, bottled teas (16 oz.) contain fewer than one cup of brewed tea.

CANCER

From anecdotal evidence, epidemiological and experimental models, tea is thought to have cancer preventive effects.   A prospective study of a group of Japanese people younger than 79 years old after a 13-year follow-up indicated a delay of cancer onset and cancer-related death, as well as all-cause mortality with an increased consumption of green tea.  Another cohort of 8,552 general residents of Japan presented evidence for preventive effects of drinking green tea on both cancer and heart disease.  In one animal study, researchers showed that green tea as a main beverage in the diet of mice could suppress colon cancer.  Another study suggested a reduction of chronic inflammation by green tea which may be associated with cancer and heart disease.

There are few human studies on green tea.  Generally cancer risk is reduced more in those people who consume green tea than black tea since the polyphenols in black tea are not absorbed as well.  Studies show that the amount of tea consumed effects cancer prevention effects – i.e. the range has been from two to three cups of green tea per day to 10 cups per day.

HEART DISEASE

Black and green tea consumption and the risk of coronary artery disease: a meta-analysis
Conclusions: Our data do not support a protective role of black tea against CAD. The limited data available on green tea support a tentative association of green tea consumption with a reduced risk of CAD. However, additional studies are needed to make a convincing case for this association.

It appears from a meta-analysis (see abstract above through the link provided) of studies on black and green tea that there was no association with black tea and coronary artery disease; however, green tea did show a tentative association.  There are few studies on green tea; more are needed.

However, another meta-analysis reported that either green or black tea (3 or more cups) reduced ischemic stroke risk by 21%.  (Stroke, 2009; 40:1786-1792.)

WEIGHT LOSS

Green tea extracts are often found in the weight loss sections of health food stores and supermarkets. I could only find one or two studies on humans from reputable journals. Most of the studies were animal studies. The studies are inconclusive and inconsistent.  Don’t believe the hype that green tea will burn fat.

What is the Bottom Line?

If you’re looking for dramatic health benefits from tea – the evidence is not yet there.  As with most nutrition studies, there are mixed results.  The problem may be that tea consumption is variable as far as amounts of cups consumed.  Some bottled teas have added sugar; some people add sugar to brewed tea; some add milk.  Most epidemiological studies are based on recall or observation, which is always a problem in these types of studies.  One drawback of overconsumption is that the polyphenols in tea interfere with nonheme iron absorption that can lead to anemia.

Tea has been around for the last 2,000 years and is the beverage of choice of many Asian countries.  There is no reason to not enjoy it.  If you have not tried green tea, do so.  It may take a while to get used to it; however, it may be the best bet for health.  Everyone can benefit from any tea. It has the potential to offer powerful antioxidant protection, reduce blood sugar, is anti-inflammatory, and lowers cholesterol. For a common little beverage that costs next to nothing – that’s a pretty powerful resume.

 

FAD DIETS: A TIMELINE

Fad diets have in the distant past have embraced some of the most bizarre activitir with most built on gimmicks. Included in an entertaining book titled Calories & Corsets, our ancestors relied on recommendations that included “suspending themselves in weighing chairs or lukewarm baths, drinking vinegar and eating carbolic soup in the hopes of shedding unwanted pounds.”

A rice diet was designed in the 1940s to lower blood pressure; now it has resurfaced as a Weight Loss Diet. The first phase consists of eating only rice and fruit until you can’t stand them any longer. Another novelty diet is the egg diet, on which you eat all the eggs you want. On the Beverly Hills diet, you eat mostly fruit.

The most bizarre of the novelty diets proposes that food gets stuck in your body. A common supposition from the 1800’s is that food gets stuck in the intestine, putrefies, and creates toxins, which invade the blood and cause disease. This leads to the headlines proclaiming the latest detox formula of strange concoctions of foods that if consumed promise to “cleanse” the blood.  This is utter nonsense.

How to recognize a fad diet.

  • They promote quick weight loss. This primarily results from glycogen, sodium, and lean muscle mass depletion. All lead to a loss of body water.
  • They limit food selection and dictate specific rituals, such as eating only fruit for breakfast or cabbage soup every day.
  • They use testimonials from famous people and bill themselves as cure-alls. They often recommend expensive supplements.
  • Probably the cruelest characteristic of fad diets is that they essentially guarantee failure for the dieter since these diets are not designed for permanent weight loss. Habits are not changed, and the food selection is so limited that the person cannot follow the diet in the long run.
  • The dieter appears to have failed, when actually the diet has failed. This whole scenario can add more blame and guilt, challenging the self-worth of the dieter.  If someone needs help losing weight, professional help is advised.
  • It should be noted that some “fad” diets can work for weight loss due to their highly restrictive nature but should not be considered a healthy diet since their long term effects are not usually known.  A good example is the current ketogenic (keto) diet.

FAD DIET TIMELINE

Slimming down through the ages through fad diets has been around for centuries from President Taft to Victoria Beckham. Here’s a look at some of the most famous and infamous moments in diet fad history.

1820 Lord Byron brings people the once popular vinegar and water diet which entails drinking water mixed with apple cider vinegar.

1903 President William Howard Taft pledges to slim down after getting allegedly getting stuck in the White House bathtub.

1925 Lucky Strike cigarette brand launches the “reach for a Lucky” instead of a sweet” campaign capitalizing on its nicotine content.

1930s The Grapefruit Diet also known as the Hollywood diet is born. The popular plan calls for eating grapefruit with every meal. Grapefruit is claimed to have fat burning capabilities.

1950s the Cabbage Soup Diet promises you can lose 10 to 15 pounds a week by eating a limited diet including cabbage soup every day.

Mid-1950 Urban legend has it that opera singer Maria Callas dropped 65 pounds on the Tapeworm Diet by swallowing a the tapeworm parasite in a pill.

1963 Weight Watchers is founded by Jean Nidetch “a self-described overweight housewife obsessed with cookies.”

1969 Jazzercise founded by professional dancer Judi Sheppard Missett, is a combination of aerobics exercise and dance.

1970 Sleeping Beauty Diet which involves drug sedation is rumored to have been tried by Elvis Presley.

1975 A Florida doctor. creates the Cookie Diet, a plan where you eat cookies made with a blend of amino acids Hollywood eats it up.

1977 A Slim Fast shake for breakfast, a shake for lunch, then a sensible dinner becomes a diet staple.

1978 Dr. Herman Tarnower, a cardiologist publishes the Complete Scarsdale Medical Diet. Two years later he is shot by his girlfriend, a headmistress of a girl’s school, Jean Harris. (not related to a diet).

1979 Dexatrim, a pill  containing phenylpropanolamine (PPA), appears on drugstore shelves. It’s formula changes after PPA is linked to an increased risk of stroke in 2000.

1980s A popular appetite suppressant candy called Ayds is taken off the market after the AIDS crisis hits.

1982 The aerobics craze sweeps into high gear when Jane Fonda launches her first exercise video work- out starring herself.  Her catchphrase “no pain no gain.”

1985 Harvey and Marilyn Diamond publish Fit for Life, which prohibits complex carbs and proteins from being eaten during the same meal.

1987 in her memoir/self-help book Elizabeth Takes Off, actress Elizabeth Taylor advises dieters to eat veggies and dip each day at 3 PM.

1988 Wearing a pair of size 10 Calvin Klein jeans, Oprah walks onto the stage pulling a wagon full of fat to represent the 67 pounds she lost on a liquid diet.

1991 Americans are still obsessed with  low fat food like McDonald’s Mclean Deluxe burger. The recipe called for seaweed extract called carrageenan. Beef made up only 90 percent of the patty, and water and carrageenan made up the remaining 10 percent.  Despite the addition of “natural” beef flavor additives, the result was a dry failure of a burger that was later called “the McFlopper”. Johnnie Carson made many jokes about it.

1994 The guide to nutrition labeling and education act requires food companies to include nutritional info on nearly all packing packaging.

1995 The Zone Diet called for a specific ratio of carbs, fat and protein in each meal and begins to attract celeb fans.

1996  Could your blood type determine how much weight you could lose? That’s the idea behind the Blood Type Diet, created by naturopath Peter J. D’Adamo.  He claims that the foods you eat react chemically with your blood type. If you follow a properly designed diet for your type,  your body will digest food more efficiently and you will lose weight and be healthier.

1997 Robert C. Atkins, MD publishes Dr. Atkins New Diet Revolution, A high protein low carb plan. A previous book was published as Dr. Atkins Diet Revolution in 1972. It took the diet world by storm, since its primary goal was to eat fat, not avoid it. Fat-starved people loved it.

2000 Gwyneth Paltrow lends her support for the macrobiotic diet, a very restrictive Japanese plan based on whole grains and veggies.

2001 Renee Zellweger packs on nearly 30 pounds to play Bridget Jones.

2003 Miami Dr. Arthur Agatston adds fuel to the low carb craze by publishing the South Beach diet, seen as a more moderate version of Atkins.

Early 2000 The FDA bans the sale of diet drugs containing ephedrine after it’s linked to heart attacks.

Late 2000 The Biggest Loser makes its debut on TV, turning weight loss into a reality show. All but one contestant regained all their weight loss back after the show ended.

2006 Beyoncé admits to using the Master Cleanse, a concoction of hot water lemon juice maple syrup and Cayenne pepper to shed 20 pounds for “Dream Girls.”

2007 Alli hits the market. The non-prescription drug is taken with meals to keep your body from absorbing some of the fat a you eat. The drug was not popular due to unpleasant gastrointestinal side effects.

2010 Jennifer Hudson loses a jaw-dropping 80 pounds on Weight Watchers.

2011 The hCG diet combines a fertility drug with a strict 500 to 800 calorie a day regimen that invites interest and criticism. The FDA has called this diet dangerous, illegal and fraudulent.

2012 Jessica Simpson loses 60 pounds of baby weight on Weight Watchers.

NOTE: In our current virus centered world, hope these fad diets bring a few smiles to your face.

Vitamin D: An Anti Inflammatory Vitamin?

Vitamin D Foods

Study: Patients Low In Vitamin D Twice As Likely To Develop Severe COVID-19 Symptoms

Here are some facts about vitamin D.  It is important to remember that just one study is only an observation but can be used to form a hypothesis for further research.  Actually vitamin D is now thought of as a hormone that is involved with helping to build strong bones. Also as a hormone, it plays key  roles in combating chronic inflammation. It does this by entering cells and turning genes that produce Inflammatory substances “off” and those that produce substances that reduce inflammation “on.” In our days of living with the pandemic, we need to pay attention to the dietary factors that may help curtail the effects of the coronovirus or COVID-19.

Inadequate vitamin D status is common.

How to Improve your vitamin D status:

  • Substitute a cup of skim milk for a sweetened beverage at one meal or snack a day.
  • Eat salmon once a week at dinner.
  • Select a vitamin D-fortified orange juice.
  • Buy or select and consume vitamin D-fortified breakfast cereals.
  • Exercise or walk in sunshine for 10 minutes three times a week. Best to wear shorts or short sleeves for better exposure (weather dependent, of course). Vitamin D is manufactured from a form of cholesterol in skin cells upon exposure to ultra-violet rays from the sun. You cannot get too much vitamin D from sun exposure.
  • Take a vitamin D supplement (400-600 IU) daily until you are able to get enough vitamin D through dietary means. NOTE: Please get your doctor’s permission to take vitamin D supplements since it is classified as a fat soluble vitamin and can be toxic at high doses (4,000 IU/ is the upper Tolerable Level) or 100 ug/day.  Check labels carefully. Source: Nutrition Now, 7th Edition, Judith E. Brown

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