Don’t wait to take action until it’s too late
High blood insulin levels and insulin resistance promote age-related degeneration of the brain, leading to memory loss and dementia according to Robert Krikorian, Ph.D. He’s a professor in the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati Academic Health Center. He has an article in a recent issue of Current Psychiatry – Online.
Proper insulin signaling in the brain is important for healthy functioning of our brains’ memory centers. This signaling breaks down in the setting of insulin resistance and the associated high insulin levels. Dr. Krikorian makes much of the fact that high insulin levels and insulin resistance are closely tied to obesity. He writes that:
Waist circumference of ≥100 cm (39 inches) is a sensitive, specific, and independent predictor of hyperinsulinemia for men and women and a stronger predictor than body mass index, waist-to-hip ratio, and other measures of body fat.
Dr. Krikorian thinks that dietary approaches to the prevention of dementia are effective yet underutilized. He mentions reduction of insulin levels by restricting calories or a ketogenic diet: they’ve been linked with improved memory in middle-aged and older adults.
Dr. K suggests the following measures to prevent dementia and memory loss:
- eliminate high-glycemic foods like processed carbohydrates and sweets
- replace high-glycemic foods with fruits and vegetables (the higher polyphenol intake may help by itself)
- certain polyphenols, such as those found in berries, may be particularly helpful in improving brain metabolic function
- keep your waist size under 39 inches, or aim for that if you’re overweight
I must mention that many, perhaps most, dementia experts are not as confident as Dr. Krikorian that these dietary changes are effective. I think they are, to a degree.
The Mediterranean diet is high in fruits and vegetables and relatively low-glycemic. It’s usually mentioned by experts as the diet that may prevent dementia and slow its progression.
Read the full article.
I’ve written before about how blood sugars in the upper normal range are linked to brain degeneration. Dr. Krikorian’s recommendations would tend to keep blood sugar levels in the lower end of the normal range.
Steve Parker, M.D.
PS: Speaking of dementia and ketogenic, have you ever heard of the Ketogenic Mediterranean Diet? (Free condensed version here.)
Posted in Alzheimer Disease, Dementia, Glycemic Index, Ketogenic Mediterranean Diet, Overweight & Obesity, Uncategorized
Tagged berries, body mass index, dementia, diet, fruit, glycemic index, low carb, Mediterranean diet, memory loss, obesity, Robert Krikorian, vegetables
It may be related to leptin, a hormone produced by fat cells (adipocytes). ScienceDaily has all the details, most pertinent of which is that the study at hand was done in mice. So not ready for prime time (humans). Some of the sickest asthmatics I’ve cared for have been morbidly obese.
Relaxing after a hard day gathering nuts and berries
Have our modern conveniences contributed to the fact that two thirds of us are overweight or obese? It would make sense, because we should be burning fewer calories in the activities of daily living. If our daily workload decreases but we eat the same old calories, they gotta go somewhere, right? Like into our fat stores.
We no longer have to walk down to the river to fetch a five-gallon bucket of water for washing. No longer do we go out a forage for food and firewood. We don’t even have to get up off the couch to change the channel on the TV.
Hunter-gatherer societies don’t have our modern conveniences. You’d think they burn a lot more calories than us in activities of daily living. You’d be wrong.
At least one group of hunter-gatherers doesn’t burn any more calories in physical activity than Western cultures. So much for blaming our excess weight on low activity levels and labor-saving technology.
BBC article on energy expenditure of the Hazda hunter-gatherer culture.
h/t Colby Vorland at nutsci.org
No doubt you have noticed the expanding girths of U.S. yoots. What are the health implications? Research published in the New England Journal of Medicine suggests a disturbing answer.
Heavy youths tend to stay heavy as they age. Researchers looked at the incidence of overweight adolescents in the year 2000 and then estimated the prevalence of obesity in the year 2020. Thirty to 44% of 35-year-olds in 2020 are expected to be obese.
Using computer simulation, investigators estimated that by 2035 the prevalence of coronary heart disease will increase by 5 to 16% because of the increased obesity. In other words, the increasing obesity in these young and middle-aged adults will result in over 100,000 excess cases of coronary heart disease.
That is, if current trends continue. But I see nothing on the horizon likely to alter that societal trend in the near future. I’m doing my part. How about you?
Steve Parker, M.D.
References: Bibbins-Domingo, K, et al. Adolescent Overweight and Future Adult Coronary Heart Disease. New England Journal of Medicine, 357 (2007): 2,371-2,379.
Claims that “diets don’t work” are based on the assumption that any weight lost is simply gained back quickly.
The Endocrine Society met in Toronto in June of 2007. Experts presented data on maintenance of weight loss by overweight people. What percentage of people who lost 10% of their weight kept the weight off for one year? About 20%. Not great, but better than many would expect. That’s a 200-pounder losing down to 180 and staying at 180 pounds for a year. This degree of weight loss will improve many cases of high blood pressure, knee arthritis, and type 2 diabetes mellitus.
The U.S. Centers for Disease Control and Prevention reports even better data. Almost 60% of 1,310 people in the National Health and Nutrition Examination Survey who lost 10% of body weight maintained 95% of the loss for one year.
How do they keep the weight off? Characteristics of “successful losers” include a low-calorie diet (probably 1,6oo-1,800 on average), weighing at least once per week, and burning about 2,600 calories per week in physical activity. (A 150-pound person expends 1260 calories a week by walking 3-4 mph for 30 minutes daily.)
Many successful losers cycle through weight loss and gain several times before determining which combination of diet and physical activity ultimately works for them.
So don’t give up!
Steve Parker, M.D,
McGuire, M.T., et al. International Journal of Obesity, 23 (1999): 1,314-1,319.
Weiss, E.C., et al. American Journal of Preventive Medicine, 33 (2007): 34-40.
I often talk to people interested in improving their health or losing weight via lifestyle modification, mostly changes in diet and exercise. Many of them are motivated by health-related facts. Here is a smattering of facts I compiled in 2008 (so some are outdated), starting out worrisome and ending hopeful:
65% of U.S. adults are overweight or obese. Half are overweight, half are obese.
12% of deaths in the U.S. are due to lack of regular physical activity – 250,000 deaths yearly.
11% of U.S. adults have diabetes mellitus.
24 million in the U.S. have diabetes. Another 57 million have pre-diabetes, a condition that increases your risk for diabetes.
23% of U.S. adults over 60 have diabetes.
85% of people with type 2 diabetes are overweight.
200,000 yearly deaths in the U.S. are due to obesity.
Excess body fat causes 14 to 20% of all cancer-related deaths in the U.S.
550,000 people die yearly of cancer in the U.S.
Obesity-related cancers in men: prostate and colorectal. Obesity-related cancers in women: endometrial (uterine), cervix, ovary, breast. Both sexes: kidney, esophageal adenocarcinoma.
20% of us in the U.S. will die of cancer.
Lifetime risk of developing invasive cancer in the U.S. is four in 10 (a little higher in men, a little lower in women).
At least one-half of high blood pressure cases are caused by excess body fat. Every 20 pounds of excess fat increases blood pressure by two to three points.
Peak aerobic power (a measure of physical fitness) decreases by 50% between age 20 and 65.
Middle-aged and older people through regular exercise can increase their aerobic power by 15 to 20%, equivalent to a 10 or 20-year reduction in biological age.
Regular aerobic exercise reduces blood pressure by 8 to 11 points.
Have you already had a heart attack? If so, regular exercise reduces the odds of fatal recurrence by 25% and adds two to three years to life.
The Mediterranean diet is associated with lower incidence of cancer (colon, breast, prostate, uterus), cardiovascular disease (e.g., heart attacks), and dementia (both Alzheimers and vascular types).
High fruit and vegetable consumption protects against cancer of the lung, stomach, colon, rectum, oral cavity, and esophagus. The protective “dose” is five servings a day.
Coronary artery disease is the cause of heart attacks and many cases of sudden cardiac death. Legume consumption lowers the risk of coronary artery disease. The protective dose is four servings of legumes a week.
Whole grain consumption is associated with reduced risk of coronary artery disease (e.g., heart attacks), lower risk of death, lower incidence of type 2 diabetes and several cancers. The protective dose is three servings a day.
The good news is that we can significantly reduce our risk of premature death and common illnesses such as high blood pressure, cancer, diabetes, coronary artery disease, and dementia. How? Weight management, diet modification, and physical activity.
Steve Parker, M.D.
In 2008, the United Nation’s Food and Agriculture Organisation reported rates of overweight and obesity in various countries in the European Union.
Greece won honors as the fattest EU country – 75% of adult Greeks are overweight or obese. Way to go, Greece! Over the 40 years preceeding 2002, the Greeks increased their average caloric intake by 30%, compared to a 20% increase in the rest of the EU. And I’d bet they’re expending fewer calories in physical activity than did the Greeks of 40 years ago.
Although outdone by the Greeks, over half of the adult populations in Italy, Spain, and Portugal are overweight, too.
The authors of the UN report suggest reasons for Greece’s decisive capture of first place:
- more sedentary lifestyles
- less home cooking
- supermarkets and fast-food restaurants offering convenient, processed foods high in sugar, animal fat, and salt. [Salt should have nothing to do with weight gain.]
- less fruit and vegetable consumption
In other words, they’ve been moving away from the traditional Mediterranean diet and lifestyle of the mid-20th century. Recent observational studies in Greece and Spain showed less obesity in current residents who had higher adherence to the traditional Mediterranean diet.
How do North American adult overweight and obesity rates compare?
- United States – 67%
- Mexico – 63%
- Canada – 59%
If the Mediterraneans have forgotten their dietary heritage, I can help.
Steve Parker, M.D.
Mendez, M.A., et al. Adherence to a Mediterranean diet is associated with reduced 3-year incidence of obesity. Journal of Nutrition, vol. 136 (2006): 2,934-2,938.
Panagiotakos, D.B., et al. Association between the prevalence of obesity and adherence to the Mediterranean diet: the ATTICA study. Nutrition, vol 22 (2006): 449-456.
As a physician, I see many illnesses and conditions that are caused or aggravated by overweight and obesity. Both terms refer to excess body fat; obesity is a greater degree of fat.
Body mass index (BMI) is used to define overweight and obesity. Your BMI is your weight in kilograms divided by your height in meters squared. A BMI between 18.5 and 25 is considered healthy. BMIs between 25 and 30 are overweight. Here’s an online BMI calculator. For example, a 5-foot, 4-inch person enters obesity territory - BMI over 30 – when weight reaches 174 pounds (79 kilograms). A 5-foot, 10-incher is obese starting at 208 pounds (94.5 kilograms).
People trying to lose excess fat typically have days when willpower, discipline, and commitment waver. On those days, it can help to remember why they started this adventure in the first place. The reasons for many involve improved health and longevity. Even if you have just 20 pounds of excess fat to lose, it will often take twenty weeks. Your weight-loss goal is one to one-and-a-half pounds a week. This race is won not by the swift, but by the slow and steady.
Here’s a laundry list of obesity-related conditions to remind you why you want to avoid obesity:
- Premature death. It starts at BMI of 30, with a major increase in premature death at BMI over 40. The U.S. has 200,000 yearly deaths directly attributable to obesity.
- Arthritis, especially of the knees.
- Type 2 diabetes melllitus. Eight-five percent of people with type 2 diabetes are overweight.
- Increased cardiovascular disease risk, especially with an apple-shaped fat distribution as compared to pear-shaped. Cardiovascular disease includes heart attacks, high blood pressure, strokes, and peripheral arterial disease (poor circulation).
- Obstructive sleep apnea.
- Gallstones are three or four times more common in the obese.
- High blood pressure. At least one third of cases are caused by excess body fat. Every 20 pounds of excess fat raises blood pressure 2-3 points (mmHg).
- Tendency to higher total and LDL cholesterol, higher triglycerides, while lowering HDL cholesterol. These lipid changes are associated with hardening of the arteries – atherosclerosis – which can lead to heart attacks, strokes, and peripheral arterial disease.
- Increased cancers. Prostate and colorectal in men. Endometrial, gallbladder, cervix, ovary, and breast in women. Kidney and esophageal adenocarcinoma in both sexes. Excess fat contributes to 14-20% of all cancer -related deaths in the U.S. Over 550,000 people die from cancer in the U.S. yearly. Twenty percent of us will die from cancer.
- Low back pain.
- Varicose veins.
- Blood clots in legs and lungs.
- Surgery complications: poor wound healing, blood clots, wound infection, breathing problems.
- Pregnancy complications: toxemia, high blood pressure, diabetes, prolonged labor, greater need for C-section.
- Fat build-up in liver.
- Low sperm counts.
- Decreased fertility.
- Delayed or missed diagnosis due to difficult physical examination or weight exceeding the limit of diagnostic equipment.
I hope you find this information motivational rather than depressing. For those already obese, weight loss can significantly improve, alleviate, or prevent these conditions. Many obesity-related medical conditions and metabolic abnormalities are improved with loss of just five or 10% of total body weight. For instance, a 240 pound man with mild diabetes and high blood pressure may be able to reduce or avoid drug therapy by losing just 12 to 24 pounds. He’s still obese, but healthier.
Steve Parker, M.D.
The U.S. Food and Drug Administration today approved lorcaserin hydrochloride as a weight-loss drug, according to MedPage Today.
The drug, to be sold as Belviq in the U.S., is an activator of the serotonin C2 receptor in the brain. This may reduce food consumption by producing early satiety at mealtime.
According to the FDA’s press release, “the most common side effects of Belviq in non-diabetic patients are headache, dizziness, fatigue, nausea, dry mouth, and constipation, and in diabetic patients are low blood sugar (hypoglycemia), headache, back pain, cough, and fatigue.”
I rarely prescribe weight-loss drugs for my patients. They’re expensive. They have side effects. They’re not very effective. And when you stop the drug, the fat returns.
Steve Parker, M.D.