Category Archives: Overweight & Obesity

Is Hypertension a True Risk Factor for Serious Illness from #COVID19? #Coronavirus

“I’ll practice extreme social distancing even after house-arrest is lifted for others.”

BREAKING NEWS: Gray hair is a risk factor for serious COVID-19 infection.

I keep reading that hypertension (high blood pressure) makes one vulnerable to COVID-19. For instance, many patients hospitalized in New York  had hypertension. The implication is that something about hypertension weakens your immune system such that you’re more likely to die.

In the study linked above, average age of all hospitalized was 63. Fifty-seven percent of them had hypertension. Most healthcare providers know that the prevalence of hypertension rises with age. So you’d expect lots of 63-year-olds to have hypertension. At least 25% of them, right?

With just ten seconds of googling, I found that the prevalence of hypertension in the U.S. for those 60 and older is 63%. I fully expect my blood pressure would be higher than it is now if I lived in New York City, which I’ll never do.

If you’re 63-years-old and hospitalized in New York City for anything, odds are you’re likely to have hypertension. Just like you’re more likely to have gray hair than someone younger. Hypertension and gray hair are incidental markers for advancing age. They don’t per se increase your risk of serious illness from COVID-19.

Now, that being said, be aware that uncontrolled hypertension can damage some major organs that are important for health and longevity. That’s why we treat it. That damage can weaken your heart, kidneys, arteries, and brain. You need those systems to help you fight off any serious infection, not just COVID-19. If you already have organ damage from uncontrolled hypertension, I’ll bet that increases your chances of a bad outcome from any serious infection. Regarding hypertension and function of the immune system, I’m not aware of any good data or connection.

My first link above was to a JAMA Network article detailing the co-morbidities of over 5,000 New York City area residents hospitalized with COVID-19. A few other data points from it:

  • 42% were obese. What’s the obesity rate for 63-year-olds in New York City? I don’t know. Among all adults in New York state, the prevalence of obesity is 28%. This is about 3 points lower than the national average.
  • 34% had diabetes. The study authors don’t make it easy to find, but I bet this is mostly type 2 diabetes. I don’t know the prevalence of diabetes in New York City. In the U.S. overall, among those 65 or older, the prevalence of diabetes is 27%. I’d say at least 90% of that is type 2 diabetes. That 27% includes the 5% who don’t know they have it.
  • Mortality rates for those who received mechanical ventilation in the 18-to-65 and older-than-65 age groups were 76.4% and 97.2%, respectively. Those mortality rates are scary high, but let’s not put too much emphasis on them yet since some of these folks were still in the hospital at the time the report was prepared.

Tracheal intubation in prep for mechanical ventilation

Bottom Line

If I were a 30-years-old and had well-controlled hypertension or gray hair, I wouldn’t worry much about my risk of COVID-19. On the other hand, if I were obese, I’d work on fixing that, starting NOW. Regarding diabetes, if you can’t cure it, keep it under control.

Steve Parker, M.D.

PS: Did you know the definition of hypertension changes over time? Even the one below is outdated. The linked CDC report above used this definition:

Hypertension: Systolic blood pressure greater than or equal to 140 mmHg or diastolic blood pressure greater than or equal to 90 mmHg, or currently taking medication to lower high blood pressure.

PPS: Admittedly, “60 and older” includes 93-year-olds.   You may argue that the incidence of hypertension among 93-year-olds is 85% compared to 45% in 60-70 year-olds. Please do the research and show your work. I’m out of time.

PPPS: Overall prevalence of hypertension in the U.S. is 29%. Curious about the incidence of hypertension in other U.S. age groups?

  • age group 18-39: 7.5%
  • age 40-59: 33.2%
  • 60 and over: 63.1%
Steve Parker MD, Advanced Mediterranean Diet

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords. com.

Click pic to purchase at Amazon.com. E-book versions also available at Smashwords. com.

 

A New Theory of Obesity 

paleo diet, paleolithic diet, caveman diet

Not Kevin Hall

At Scientific American:

Nutrition researcher Kevin Hall strives to project a Zen-like state of equanimity. In his often contentious field, he says he is more bemused than frustrated by the tendency of other scientists to “cling to pet theories despite overwhelming evidence that they are mistaken.” Some of these experts, he tells me with a sly smile, “have a fascinating ability to rationalize away studies that don’t support their views.”

Among those views is the idea that particular nutrients such as fats, carbs or sugars are to blame for our alarming obesity pandemic. (Globally the prevalence of obesity nearly tripled between 1975 and 2016, according to the World Health Organization. The rise accompanies related health threats that include heart disease and diabetes.) But Hall, who works at the National Institute of Diabetes and Digestive and Kidney Diseases, where he runs the Integrative Physiology section, has run experiments that point fingers at a different culprit. His studies suggest that a dramatic shift in how we make the food we eat—pulling ingredients apart and then reconstituting them into things like frosted snack cakes and ready-to-eat meals from the supermarket freezer—bears the brunt of the blame. This “ultraprocessed” food, he and a growing number of other scientists think, disrupts gut-brain signals that normally tell us that we have had enough, and this failed signaling leads to overeating.

*  *  *

At the end of the 19th century, most Americans lived in rural areas, and nearly half made their living on farms, where fresh or only lightly processed food was the norm. Today most Americans live in cities and buy rather than grow their food, increasingly in ready-to-eat form. An estimated 58 percent of the calories we consume and nearly 90 percent of all added sugars come from industrial food formulations made up mostly or entirely of ingredients—whether nutrients, fiber or chemical additives—that are not found in a similar form and combination in nature. These are the ultraprocessed foods, and they range from junk food such as chips, sugary breakfast cereals, candy, soda and mass-manufactured pastries to what might seem like benign or even healthful products such as commercial breads, processed meats, flavored yogurts and energy bars.

Wasn’t David Kessler, M.D., saying the same things ten years ago?

Here’s another new theory from me: If you had to kill and butcher your own animals, you’d eat less.

Steve Parker, M.D.

Steve Parker MD, Advanced Mediterranean Diet

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords. com.

Avoid Ultra-Processed Foods to Help With Weight Management

From Cell Metabolism:

We investigated whether ultra-processed foods affect energy intake in 20 weight-stable adults, aged (mean ± SE) 31.2 ± 1.6 years and BMI = 27 ± 1.5 kg/m2. Subjects were admitted to the NIH Clinical Center and randomized to receive either ultra-processed or unprocessed diets for 2 weeks immediately followed by the alternate diet for 2 weeks. Meals were designed to be matched for presented calories, energy density, macronutrients, sugar, sodium, and fiber. Subjects were instructed to consume as much or as little as desired. Energy intake was greater during the ultra-processed diet (508 ± 106 kcal/day; p = 0.0001), with increased consumption of carbohydrate (280 ± 54 kcal/day; p < 0.0001) and fat (230 ± 53 kcal/day; p = 0.0004), but not protein (−2 ± 12 kcal/day; p = 0.85). Weight changes were highly correlated with energy intake (r = 0.8, p < 0.0001), with participants gaining 0.9 ± 0.3 kg (p = 0.009) during the ultra-processed diet and losing 0.9 ± 0.3 kg (p = 0.007) during the unprocessed diet. Limiting consumption of ultra-processed foods may be an effective strategy for obesity prevention and treatment.

Source: Ultra-Processed Diets Cause Excess Calorie Intake and Weight Gain: An Inpatient Randomized Controlled Trial of Ad Libitum Food Intake: Cell Metabolism

Steve Parker, M.D.

Steve Parker MD, Advanced Mediterranean Diet

Click the pic to purchase at Amazon.com

ABitOfBritt on HAES: Health at Every Size

George Monbiot Ponders Why Brits Have Gotten So Fat

…in an article at The Guardian. He thinks the trend start in 1976.

Why?

So what has happened? The light begins to dawn when you look at the nutrition figures in more detail. Yes, we ate more in 1976, but differently. Today, we buy half as much fresh milk per person, but five times more yoghurt, three times more ice cream and – wait for it – 39 times as many dairy desserts. We buy half as many eggs as in 1976, but a third more breakfast cereals and twice the cereal snacks; half the total potatoes, but three times the crisps. While our direct purchases of sugar have sharply declined, the sugar we consume in drinks and confectionery is likely to have rocketed (there are purchase numbers only from 1992, at which point they were rising rapidly. Perhaps, as we consumed just 9kcal a day in the form of drinks in 1976, no one thought the numbers were worth collecting.) In other words, the opportunities to load our food with sugar have boomed. As some experts have long proposed, this seems to be the issue.

Source: We’re in a new age of obesity. How did it happen? You’d be surprised | George Monbiot | Opinion | The Guardian

Contrary to the above, we in the U.S. have been eating significantly more calories over the last 50 years. I’m surprised George didn’t mention the dramatic increase in industrial seed oil consumption over same time frame.

The problem cannot be reduced to sugar consumption alone.

Steve Parker, M.D.

How Did the U.S. Get Fat?

Your average Americans

There’s no shortage of speculation as to why 70% of us in the U.S. are overweight or obese. A few possibilities include:

  • we’re too sedentary
  • we eat too many carbohydrates
  • we eat too much fat
  • our foods are over-processed
  • we eat away from home too often
  • we eat too many industrial seed oils
  • our water and food are contaminated with persistent organic pollutants that disrupt our endocrine systems

I was reading an article at Nutrition Today and came across this graph of calorie consumption change from 1971 to 2004 (or 2000?):

The verbal summary is from this article cited by the cited by the Nutrition Today authors: During 1971—2000, a statistically significant increase in average energy intake occurred. For men, average energy intake increased from 2,450 kcals to 2,618 kcals, and for women, from 1,542 kcals to 1,877 kcals. So men’s daily calorie intake went up by 168, and women’s by 335.

The original article I read states, alternatively, that men’s daily caloric consumption rose from 2450 to 2693, a gain of 243. I can’t explain the discrepancy between 243 and 168, nor why 2004 is in the graph instead of 2000.

Maybe you don’t think an extra 168 calories a day is much. If you believe in the validity of the Energy Balance Equation, those 168 daily calories will turn into  17.5 pounds of fat in a year unless you “burn them off” somehow. If you weigh 150 lb (68 kg), you can burn those 168 calories by doing a daily 15-minute jog at 5.5 mph (8.9 km/hr). But you ain’t gonna do that. (I’m not getting into a debate about validity of the equation now; for another perspective, read Lyle McDonald.)

But year 2000 was a long time ago. How much are Americans eating now? According to a 2016 report from Pew Research Center:

Broadly speaking, we eat a lot more than we used to: The average American consumed 2,481 calories a day in 2010, about 23% more than in 1970. That’s more than most adults need to maintain their current weight, according to the Mayo Clinic’s calorie calculator. (A 40-year-old man of average height and weight who’s moderately active, for instance, needs 2,400 calories; a 40-year-old woman with corresponding characteristics needs 1,850 calories.)

Bottom line? We’re eating more than we did in 1970. Which could explain why we’re fat. Unless we’re burning more calories than we did in 1970. Which I doubt.

Steve Parker, M.D.

PS: In scientific literature, kcal is what everybody else calls a calorie.

Humans Are By No Means the Only Species Getting Fat

I heard about this phenomenon years ago. It’s good to remember that obesity isn’t a simple straightforward process. Like Fanatic Cook, I wonder about pollution as a cause.

“A dramatic rise in obesity has occurred among humans within the last several decades. Little is known about whether similar increases in obesity have occurred in animals inhabiting human-influenced environments. We examined samples collectively consisting of over 20 000 animals from 24 populations (12 divided separately into males and females) of animals representing eight species living with or around humans in industrialized societies. In all populations, the estimated coefficient for the trend of body weight over time was positive (i.e. increasing). The probability of all trends being in the same direction by chance is 1.2 × 10 [to the minus 7th power]. Surprisingly, we find that over the past several decades, average mid-life body weights have risen among primates and rodents living in research colonies, as well as among feral rodents and domestic dogs and cats. The consistency of these findings among animals living in varying environments, suggests the intriguing possibility that the aetiology of increasing body weight may involve several as-of-yet unidentified and/or poorly understood factors (e.g. viral pathogens, epigenetic factors). This finding may eventually enhance the discovery and fuller elucidation of other factors that have contributed to the recent rise in obesity rates.”

Source: Canaries in the coal mine: a cross-species analysis of the plurality of obesity epidemics

Who Cooks These Day?

I’ve been saying for years that weigh management begins in the kitchen. Meaning preparing your own meals. An article in Nutrition Journal indicates that more folks have been cooking. But it’s not making a dent in the obesity epidemic yet.

“Cooking increased overall from 2003 to 2016. The percent of college-educated men cooking increased from 37.9% in 2003 to 51.9% in 2016, but men with less than high school education who cook did not change (33.2% in 2016) (p < 0.05). College-educated women who cook increased from 64.7% in 2003 to 68.7% in 2016, while women with less than high school education had no change (72.3% in 2016) (p < 0.05). Women with less education spent more time cooking per day than high-educated women, but the reverse was true for men. Among men, the percent who cook increased for all race/ethnic groups except non-Hispanic blacks. Among women, only non-Hispanic whites increased in percent who cook. Among both men and women, non-Hispanic blacks had the lowest percentage who cooked, and non-Hispanic others spent the greatest amount of time cooking.”

Source: Who’s cooking? Trends in US home food preparation by gender, education, and race/ethnicity from 2003 to 2016 | Nutrition Journal | Full Text

Which Foods Make People Fat?

At my other Advanced Mediterranean Diet website, a few years ago I asked visitors to answer a poll question. 2,367 responded thusly:

What single food category makes you gain the most fat weight?Fatty foods like bacon, butter, oils, nuts:
5%
Protein-rich foods: meat, eggs, fish:
0%
Sugary sweet items:
23%
Starches: bread, potatoes, peas, corn:
16%
Carbohydrates:
30%
Pastries, cake, pie, cookies:
25%
Other:
1%

Total Votes: 2367

Yes, I know it’s not a scientific poll, but it’s something. I’m not surprised at the results. I’m wishing I’d offered nuts as a choice since there are at least a few folks who gain weight on nuts, perhaps not realizing that nut calories are mostly from fat.

Steve Parker, M.D.

NASEM: Current U.S. Dietary Guidelines Aren’t Trustworthy

Back to the drawing board

NASEM is the National Academies of Sciences, Engineering, and Medicine. Dr. Andy Harris writes that:

The nation’s senior scientific body recently released a new report raising serious questions about the “scientific rigor” of the Dietary Guidelines for Americans. This report confirms what many in government have suspected for years and is the reason why Congress mandated this report in the first place: our nation’s top nutrition policy is not based on sound science.

Dr. Harris notes that since 1980, when the guidelines were first published, rates of obesity have doubled and diabetes has quadrupled.

Current recommendations to reduce saturated fat consumption and to eat health whole grains do not, after all, reduce rates of cardiovascular disease. That was my conclusion in 2009.

For a mere $68 you can read the NASEM report yourself. Better yet, read Tom Naughton’s thoughts for free.

Steve Parker, M.D.

PS: The diets I’ve designed are contrary to U.S. Dietary Guidelines.