Weight Loss Strategies- Exercise

Throughout the month of April, I've been trying to give you a slightly different look at weight loss. We all know the mantra, "eat less, exercise more" and by now, you may realize why that is an outdated notion. There is much more to weight management for many people. But I can't let the topic of weight loss go without mentioning exercise. Exercise is extremely important in weight management.

I know what most of us hear in the popular press, "The more you exercise, the more calories you burn. The more calories you burn, the more weight you will lose."

Yes- it's true but only half the picture. What's the other half of the picture? Weight is regulated by your nervous system, hormones, your immune system, the health of your gastrointestinal tract, ability to sleep and a host of other underappreciated variables. It is not based solely on how many steps you take or the minutes you put in on a treadmill.

So beyond burning calories, what else is exercise good for?
1. It changes your hormone response... even in women with hormone irregularities.
2. It improves the inflammatory milieu of your body. It lowers inflammation.
3. Increases testosterone in young men.
4. Increases IGF-1 (generally a good response) and improves blood sugar regulation.
5. Increases growth hormone levels in obese individuals.
6. Increases insulin sensitivity. In other words, makes insulin work better.
7. Increases natural killer cell activity, a part of the immune system. (In fairness, overtraining or overly aggressive exercise will actually impair immune function).

This is just a peek at the metabolic benefits of exercise. Let's take just #2 from the above list. You already know that inflammation is a major impediment to weight loss. Weight gain causes more inflammation in a vicious cycle. So how do you break that cycle? Exercise. It is clear that exercise, independent of calorie burning potential, is necessary to lose weight.

Weight Loss Strategies- Sleep

How many hours of sleep do you get a night? What time do you go to bed? Is a 7 hour night good enough for you? Is midnight-7am the equivalent sleep as 10:30pm-5:30am?

Most of us are busy enough that in order to fit in enough time for work, family and play, it seems necessary to shave a few hours off of things like sleep. But if you're interested in losing weight, this is exactly the wrong thing to do.

While the physiological processes that occur during sleep are still being heavily researched, the benefits are well known. Most chronic disease risks increase when you are chronically sleep deprived. Check out this great article from Harvard University's Division of Sleep Medicine that outlines the risks of sleep deprivation.

Let's put this into perspective. Have you ever heard people say, "that person is so skinny... she has such a fast metabolism!" Or just the opposite, "He doesn't eat that much... he must just have a slow metabolism."

Chronic sleep loss will change your metabolism. It will change the way your ...
- body handles sugar
- brain works in response to chemical cues
- insulin behaves in your body
- fats are managed by your body
- stress response is modulated through the hypothalamic-pituitary-adrenal axis (HPA)
- ... and much much more

If you think about this, you'll see that even if only 1 of these changes occurred, your risk of weight gain would go up. We could spend all day just talking about how poor insulin responses will make you fat. But if you stack on just the 5 things I've listed here and you've got a quintuple threat to your weight loss goals.

Go to sleep.

Weight Loss Strategies- Eliminate Food Allergies

Most of us are familiar with the scary types of IgE mediated food allergies like you may have read about in articles like this one in a February 2009 edition of Time Magazine.

But scientists are starting to identify different types of immune reactions involving IgG antibodies. (Your body makes 5 classes of antibodies, IgG, IgM, IgA, IgD, IgE).

People with IgG food allergies don't break out into hives or go into shock when they ingest inappropriate foods. The symptoms can be quite varied. Headaches, irritable bowel syndrome, rheumatoid arthritis and other conditions may result. Alternately, you may actually feel fine while chaos ensues internally.

In a 2008 study, researchers stated
"We show here, that obese children have significantly higher IgG antibody values directed against food antigens than normal weight children. Anti- food IgG antibodies are tightly associated with low grade systemic inflammation.... These findings raise the possibility, that anti-food IgG is pathogenetically involved in the development of obesity and atherosclerosis."

The jury is still out on IgG food allergies. Some clinicians dismiss them as irrelevant because we don't know enough about them. But the research is trending toward the recommendation that doctors identify and manage IgG food allergies.

This may be a key component in your chronic low grade inflammation and obesity.

Weight Loss Strategies- Probiotics

Gut microbiota (aka the normal bacteria that live inside your gut) also play a role in weight regulation. This article in Interdisciplinary Perspectives on Infectious Disease (Dec 2008) describes how important these bacteria are.

"... imbalances in the composition of gut microbiota have been associated with susceptibility to infections, immune-based disorders, and recently also with insulin resistance and body weight gain"

Does an imbalance in gut flora promote obesity or do obese people have imbalances? It becomes a bit of a 'chicken and egg' scenario. More than likely, it's a bit of both.

Without a doubt, steady diets of junk food promote obesity as well as gut flora imbalances. On the other hand, when gut flora balance is disturbed, energy regulation, nutrient absorption, immune function and hormone activity are all dysregulated.

From the same article above,
"The metabolic role of the gut microbiota is essential to the biochemical activity of the human body, resulting in salvage of energy, generation of absorbable compounds, and production of vitamins and other essential nutrients... "

Bottom line:
Probiotics may play a role in your overall strategy toward weight loss. It is not a weight loss method alone. But it plays a significant role in shifting your overall physiology to health and metabolic balance.

Obesity- Inflammation

You've probably all heard of inflammation. If you've ever sprained an ankle, you've seen and felt inflammation. But inflammation also happens internally and can be chronic with obesity. There's been a huge amount of research into this area and the consensus is that fat tissue releases signals that cause inflammation.

Inflammation is a product of your immune system and is characterized by immune cell infiltration into tissue. The immune system is actually a 'fighting' or 'defense' system. Inherently, it is good. But realize that whenever there is a battle, there are casualties and damages to the surroundings. For example, if you've every watched a superhero movie (Spiderman, Batman, Superman etc. ), you know that as they fight the bad guys, cars are overturned, buildings are destroyed and there may be millions of dollars in damages to the city! The immune system is a great thing to have but when its always on, there is potential for massive physiological distress.

In obesity, there is chronic low grade inflammation. This alone is problematic, but it may also lead to insulin resistance. To refresh your memory about how nasty insulin resistance is, go back to this blog entry.

So this is how the vicious cycle goes:
You are obese. Your fat tissue generates chronic inflammation. This promotes insulin resistance. Insulin resistance makes it harder to lose weight.

We'll talk about ways to break this cycle in other entries.

The Overweight Brain- Part 2:: Leptin Resistance

Leptin is a hormone produced by body fat that tells your brain (hypothalamus) that you are full. Here's how it works. You eat, leptin is released by your fat tissue, leptin tells the hypothalmus you are full, you lose your urge to eat and then you stop eating. It works well in most of us but scientists have revealed a phenomenon known as leptin resistance. This means that even though the hormone is released by your fat, your brain does not respond to it. The result is that you never really know that you are full so you keep eating. Here are a few things that can cause leptin resistance.

1. Inflammation: Poor diet, lack of sleep, food allergies, obesity itself and a host of other variables can promote inflammation. This can shut down the ability of the hypothalamus to respond to leptin. In other words, if you have inflammation going on, then you may not have adequate appetite regulation.

Neuroimmunomodulation 2008;15(3):189-93. Epub 2008 Sep 9.

2. Insulin resistance: There is a strong relationship between leptin resistance and insulin resistance. These 2 seem to go together like peas & carrot, peanut butter & jelly etc. Insulin resistance in and of itself is incredibly nasty. But some experts think that leptin levels even set you up for type 2 diabetes. Incredibly, some people who aren't even overweight have leptin resistance!
Journal of American College Health 2006 Nov-Dec;55(3):175-80.

3. Stress: It appears that hyperactivity of the hypothalamic-pituitary-adrenal axis (HPA axis) can lead to obesity. And it appears that the HPA axis is regulated by leptin. While the links are still being drawn, it seems likely that poor leptin regulation may interfere with the HPA axis... subsequently leading to weight gain.
Obesity 2009 Mar 19.
International Review of Cytology 2007;263: 63-102

4. High Triglycerides: When your triglycerides are elevated, leptin has a difficult time reaching the brain because it can't cross something known as the blood brain barrier. Often, triglycerides are elevated in overweight folks. Unfortunately, this means that these same folks are not going to receive the "stop eating" signal. It doesn't seem fair, does it?
Current Pharmaceutical Design 2008; 14 (16): 1606-14.

5. Homocysteine: This is a marker that has been used to predict cardiovascular risk as well as cognitive decline. When you get your routine blood tests, ask your doctor to check your homocysteine levels. Elevations in homocysteine cause leptin resistance.
Molecular Pharmacology 2008; Dec 74(6): 1610-9.

6. MSG: Monosodium glutamate, a common flavoring in processed foods can actually promote leptin resistance. Now I know that some of you are thinking. "In what dose? Is a little bit ok? Just because it happens to rats doesn't mean it happens to humans right?" Let's not make excuses. Even if we can't say with 100% confidence that this happens, the science tells us nothing is good about MSG. At best, it's neutral. At worst, it alters the activity of your brain so that you don't know when you're hungry or full.
Obesity 2008 Aug; 16(8): 1875-80

Obesity- Kids

A new study in the April 2009 edition of Archives of Pediatrics & Adolescent Medicine reports that over 18% of 4 year old children in the United States are obese. The rate differed among children of different racial/ethnic backgrounds. It broke down like this:

Native Alaskan/American Indian: 31%
Hispanic: 22%
Non-Hispanic black: 21%
Non-Hispanic white: 16%
Asian: 13%

This kind of data reflects why pediatricians are becoming increasingly concerned with 'adult' conditions like nonalcoholic fatty liver disease in kids. Liver disease in kids! Due to largely preventable causes!

I know we think birthday cake is a standard rite of passage. A small cupcake after church on Sunday is no big deal... and it's so cute to see to see frosting on the noses of little ones! One cookie as an afternoon snack is alright. A family ice cream night after a long week is a time to bond. Everything in moderation, right?

Folks- when you add up an attitude of "moderation" over a typical week, the results can be staggering. We used to see this poor attitude manifest in adults who got sick as they entered their 40's following a lifetime of "moderation." Then we started seeing 20 year olds with health problems. Then, the teenagers started showing up with diabetes. After that, the kids started getting sicker. Now, we're seeing bad habits, poor health and a bleak outlook in our 4 year olds.

Overweight Kids and Fish

Tying together the last few articles I wrote in this blog, this study links prenatal exposure to toxins in our fish with obesity.

“What we have found for the first time is exposure to certain toxins by eating fish from polluted waters may contribute to the obesity epidemic in women,” Janet Osuch, MD, MS, professor of surgery and epidemiology at Michigan State University in East Lansing, said in a press release.

This particular study looked at 2 environmental contaminant; DDE (a breakdown product of Dichloro-diphenyl-trichloroethane aka DDT, a pesticide that was banned in the 1970's) as well as PCBs (another chemical no longer produced in the United States). Only DDE was found to have a relationship with obesity.

Folks, these chemicals aren't even produced in the United States any more. So are they coming from 'less civilized' places of the world? No! They are still lingering as a result of our past negligence and lack of foresight. They are still in the environment and are creating health consequences for us and our children today.

What are we doing today that will harm the next generation's health? It is clear that we are probably the sickest generation the United States has ever seen (consider that chronic disease so prevalent in the U.S. as well as obesity and overweight rates). So if we are this sick now, and we continue to demand-consume-throw away and pollute as much as we do now, then what will the next generation see?

The Overweight Brain- Part 1: Damages

The overweight brain undergoes a few hazardous changes. Here are the problems you'll have with your brain if you are overweight.

1. Your brain will operate slowly...: Cognitive decline normally accompanies obesity. The good news is that it is reversible!
Endocrinology. 2008 May;149(5):2628-36. Epub 2008 Feb 14

2. ... but age more quickly:
Researchers think that obesity can speed up age-related changes to the brain. It also makes your brain more vulnerable to injury.
Biochimica et Biophysica Acta 2008: Oct 17.

3. You'll probably get Alzheimers...: Obesity is a risk factor for the development of Alzheimers disease. Experts say that regulating body weight is a major preventative step in avoiding Alzheimers as you age.
Current Opinion in Clinical Nutrition and Metabolic Care 2009; Jan;12(1): 15-21

4. ... or have a stroke: Obesity is a major risk factor for stroke! No surprise here.
Neurologic Clinics 2008; 26(4): 1007-45

5. Your memory will suffer: While not clearly established, there is evidence that learning and memory decline in obese individuals. We need to keep in mind that obesity is usually accompanied by hormone irregularities, widespread inflammation and immune dysregulation. Any of these may actually be the cause of brain based changes in learning and memory. Nonetheless, obesity is unhealthy and it stands to reason that normal brain function will decline.
Physiology and Behavior 2009 Jan 8;96(1):1-5. Epub 2008 Jul 29.

This is just your brain! Being overweight causes many other issues with your heart, lungs, endocrine system, immune system and more.