For losing weight, exercise is good; diet is better

Here’s standard quote: “Losing weight can improve health and reduce many of the risk factors related to diabetes and heart disease.” Unfortunately, that’s not true. The correct statement is “losing excess body fat can improve health and reduce many of the risk factors related to diabetes and heart disease.”

It may seem like a minor difference, but it makes a world of difference. Weight loss could be due to water loss or cannibalization of lean body mass (muscles and organs), neither of which will lead to any health benefits.

If you want to reduce excess body fat, you have to lower insulin levels. How do you control that on a consistent basis? Remember the 80/20 rule. That means 80 percent of your insulin control will come from following a strict anti inflammatory diet, and 20 percent will come from increased physical activity.

This means the best exercise program can be undone by the wrong diet. Physical exercise has many important benefits, such as reducing the likelihood of diabetes and heart disease, improving sense of self-worth and hanging out with like-minded individuals.

Unfortunately, initial weight loss is not one of those benefits since research has demonstrated that exercise increases one’s appetite. This is why following a strict anti inflammatory diet is imperative if you are trying to lose weight by increasing your exercise. Another helpful hint is to increase your high purity omega-3 oil intake, as it has been demonstrated that fat loss is significantly increased when high purity omega-3 oil is used in combination with exercise.

On the other hand, after you reach your weight goals, the balance of diet and exercise to maintain your weight shifts to a 50/50 balance. Now exercise becomes an ideal way to maintain your weight as long as you continue to control insulin through the anti inflammatory diet.

Nothing contained in this blog is intended to be instructional for medial diagnosis or treatment. If you have a medical concern or issue, please consult your personal physician immediately.

A calorie’s a calorie … not quite

Anyone who has tried to lose weight before I’m sure is familiar with the magic number of 3,500. That is the number of calories believed to be equivalent to one pound of body weight. Simply lower your caloric intake by 500 calories per day, and you’ll lose one pound per week. If only it were this easy. For people who like dealing with numbers, equations like this make sense, but for those of us who have tried to make this equation a reality, it can lead to frustration when the scale doesn’t change at the end of the week or as quickly as we’d like despite our hard efforts.

Unfortunately, our bodies aren’t machines and don’t always react to changes in intake or expenditure as we’d like them to. A recent commentary in the Journal of the American Medical Association by Katan and Ludwig brings this equation to light with regards to public health initiatives to influence the obesity epidemic (1).

Traditional thinking suggests that when energy intake exceeds energy expenditure, weight gain results; and when energy intake is less than energy expenditure, it leads to weight loss. In the short term this may be true, but it may not be as simple as a 500-calorie deficit per day. Katan and Ludwig point out that if someone were to consume a 60-calorie cookie every day for the rest of their lives, in theory it should produce a one-half-pound weight gain in a month, six pounds in one year and 27 pounds in a decade; but this doesn’t happen. Overfeeding studies suggest that this additional 60 calories will result in about a six-pound weight gain, which will level off after a few years. These additional calories will go into repairing, replacing, and carrying the extra body tissue (1). The same thing happens with weight loss. The initial decrease in intake and expenditure will result in weight loss, but our bodies become very efficient and go into a conservation mode where these deficits will eventually stabilize. It will take an even greater reduction in calorie intake and expenditure to accomplish a new low. Although little changes can make a difference, when dealing with the obesity epidemic, it would take drastic reductions that would be unrealistic on a personal level, so public health initiatives will need to focus on the food supply, manufacturing policies and environment to encourage change (1).

1) Katan MB, Ludwig DS. Extra calories cause weight gain–but how much? JAMA. 2010 Jan 6;303(1):65-6.

Nothing contained in this blog is intended to be instructional for medial diagnosis or treatment. If you have a medical concern or issue, please consult your personal physician immediately.

Exercise recommendations increased for women

Just when you thought you couldn’t possibly add one more thing to your plate each day, the Journal of the American Medical Association boosts the physical activity recommendations for women. The latest study suggests that for women to be successful in maintaining normal weight and gaining fewer pounds, they need to exercise for about 60 minutes per day with moderate-intensity activity (1).

The benefits of exercise are numerous from lowering the risk of chronic disease to mood-lifting abilities, but it’s important to remember that diet plays more of a role when it comes to weight loss, whereas exercise becomes more important during the weight maintenance phase.

To put this in perspective, a McDonald’s Big Mac has 575 calories, which could take about 2 ½ hours of moderate walking to burn off! You can see where watching what you eat becomes critical for weight loss versus trying to do it solely through exercise.

Diet and exercise do go hand in hand and have an important role in overall health, but the key to both is to make gradual changes so that they become sustainable. Even little changes make a big difference, whether it’s cutting back on the amount of cream and sugar you add to your coffee each day or deliberately parking at the end of the parking lot when running errands to get in more activity.

Instead of getting overwhelmed by what guidelines you should or shouldn’t be following, make one small goal a week and continue to add to it week after week, and before you know it, you’ll be on the road to a healthier you!

1. Lee IM, Djoussé L, Sesso HD, Wang L, Buring JE. Physical activity and weight gain prevention. JAMA. 2010 Mar 24;303(12):1173-9.

Nothing contained in this blog is intended to be instructional for medial diagnosis or treatment. If you have a medical concern or issue, please consult your personal physician immediately.

Water and Weight Loss: Is there a connection?

Throughout my career, a common question that arises is whether water consumption before or during a meal really helps with weight loss. A common responses to this question is that people often confuse hunger for hydration, but a recent study may provide an answer to this question that is based on science. A randomized clinical trial published in the February edition of Obesity examined how water intake might affect weight loss in overweight and obese individuals age 55-75 (1). One group received a low-calorie diet with an emphasis on increased water consumption (water group: 16 fluid ounces of water prior to each of the three daily meals), and the other received a low-calorie diet alone (non-water group).

Neither group was aware of the true intention of the study prior to participating. There were no differences between the two groups at the start of the trial with regards to age, anthropometrics, blood chemistry or physical activity. Measurements were taken at baseline and at the end of 12 weeks. At the end of the trial both groups had lost a significant amount of weight, but those who had been instructed to consume 16 fluid ounces of water prior to each meal had a 44 percent greater weight loss than the non-water group. This equated to an approximate four-pound difference between the two groups. The mechanism through which water may be impacting weight is not fully understood, but it may be in part that it reduces energy intake at each meal and increases feelings of fullness.

1) Dennis EA, Dengo AL, Comber DL, Flack KD, Savla J, Davy KP, Davy BM. Water consumption increases weight loss during a hypocaloric diet intervention in middle-aged and older adults. Obesity (Silver Spring). 2010 Feb;18(2):300-7.

Nothing contained in this blog is intended to be instructional for medial diagnosis or treatment. If you have a medical concern or issue, please consult your personal physician immediately.

Give your second brain a chance

Most people think of the brain as the primary organ that does all of the information processing for the body. Actually, you have a second brain that is just as important. This second brain is your gastrointestinal (GI) tract that constantly senses dietary input and sends the resulting information to the brain to tell it when it can switch from seeking food to other activities, such as building cathedrals. This is why biological urges always overwhelm cognitive urges. Controlling these biological urges is not a matter of willpower but an integrated hormonal balancing mechanism. Try holding your breath for 25 minutes. It simply can’t be done not due to a lack of willpower, but because after about two minutes, the body’s need for a continual supply of oxygen overwhelms any other desire or course of action. The same is true of eating. It’s not a matter of willpower that controls appetite, but continual hormonal communication from the second brain as to whether or not there are adequate calories in the pipeline that can be ultimately converted to chemical energy to keep the body going.

There are hundreds of hormones released from your second brain to relay information on the body’s current food status. Two of the most important are PYY and GLP-1. These hormones are released from L-cells deep in the lower part of the GI tract. PYY is released in response to protein (1,2), and GLP-1 is released in response to carbohydrate (3). Both hormones are important because they also regulate satiety.

Both of these hormones are significantly increased after gastric bypass surgery (4,5), and this may account for the dramatic long-term benefits of the surgery on both weight loss and diabetes (6-8). The secret of the success of gastric bypass surgery may lie in the re-routing of the GI tract, which now brings a lot more protein and carbohydrate to their receptors found in L-cells that are located in the most distant parts of the GI tract. Apparently in obese individuals, much of the ingested protein and carbohydrate is broken down and absorbed much higher up in the GI tract. As a result, a relatively small amount of these macronutrients are sensed by the L-cells resulting in limited amounts of PYY and GLP-1 released from the GI tract to suppress hunger. As a consequence, obese individuals are constantly hungry.

This also begins to explain many of the seemingly contradictory reports on the benefit of low glycemic-load diets, like the Zone Diet, for weight loss (9, 10). The end result is to state that all diets are equally effective in weight loss since a “calorie is a calorie”, and if you restrict calories, the weight loss is identical. Of course, this simple thinking neglects genetic diversity. One study done by Harvard Medical School indicated that in genetically identical rats, weight gain is strongly correlated to the glycemic load of the diet (11). Based on this study, Harvard later conducted a clinical experiment putting overweight individuals on iso-caloric diets with differing glycemic loads for 18 months (12). If you just looked at the changes in weight, both diets were equally effective, indicating again that a “calorie is a calorie”. However, if the two groups are broken into high-initial-insulin responders versus low-initial-insulin responders, you find a very different picture emerging. For the high-insulin responders, their weight loss and long-term weight maintenance was considerably better on the low glycemic-load diet, just as it was with genetically identical rats. So this means that for those with a high initial insulin response to carbohydrates, a low glycemic-load diet, like the Zone Diet, would be their most appropriate choice, indicating a “calorie is not a calorie,” especially when you take into account genetics.

So how does this all science tie together in the real world? My hypothesis is that the fast insulin responders are simply digesting the protein and carbohydrate in a meal and absorbing it at a faster rate. This means carbohydrates enter into the bloodstream at a faster rate (i.e. high glycemic index) and fewer macronutrients (both protein and carbohydrate) are able to reach the lower part of the GI tract where the L-cells are located. This means that less PYY and GLP-1 will be secreted. As a result, there is less satiety, and they are likely to consume more calories. A low glycemic-load diet delays the absorption of carbohydrates, so that more GLP-1 is released from the L-cells. But you also have to slow down the absorption of protein so more PYY can be released. The type of protein that is broken down at the slowest rate is casein coming from milk. Other proteins, such a whey and soy, are rapidly broken down and absorbed in the upper regions of the GI track ensuring very little protein will ultimately reach the L-cells, causing an increase in PYY secretion.

So the ideal diet for those overweight individuals with a high initial insulin response may not only be a low glycemic-load diet (i.e. Zone Diet), but also a diet rich in casein. That’s why I am excited by the new generation of Zone Foods. They have a low glycemic load (similar to fruits) and are also rich in casein. The combination of the two factors may result in increased satiety because the delayed digestion and absorption means more of the initial carbohydrate and protein in the meal is reaching the L-cells, thus potentially releasing more GLP-1 and PYY.

If you aren’t hungry, then cutting back on calories is much easier, especially if you have a high initial insulin response to meals. This is the science behind the new Zone Foods. The science is complex, but the actual execution of that science is not, as long as you like to eat Zone bread, Zone pasta, and Zone pizza.

References

1. Batterham RL; Heffron H; Kapoor S; Chivers JE; Chandarana K; Herzog H; Le Roux CW; Thomas EL; Bell JD; Withers DJ Critical role for peptide YY in protein-mediated satiation and body-weight regulation. Cell Metab 4: 223-233 (2006)

2. Karra E; Chandarana K; Batterham RL. “The role of peptide YY in appetite regulation and obesity.” J Physiol 587: 19-25 (2009)

3. Jang HJ, Kokrashvili Z, Theodorakis MJ, Carlson OD, Kim BJ, Zhou J, Kim HH, Xu X, Chan SL, Juhaszova M, Bernier M, Mosinger B, Margolskee RF, and Egan JM. “Gut-expressed gustducin and taste receptors regulate secretion of glucagon-like peptide-1.” Proc Natl Acad Sci U S A 104: 15069-15074 (2007)

4. Holdstock C; Zethelius B, Sundbom M, Karlsson FA, and Eden Engstrom B. “Postprandial changes in gut regulatory peptides in gastric bypass patients.” Int J Obes (Lond) 32: 1640-1646 (2008)

5. Morinigo R, Moize V, Musri M, Lacy AM, Navarro S, Marin JL, Delgado S, Casamitjana R, and Vidal J. “Glucagon-like peptide-1, peptide YY, hunger, and satiety after gastric bypass surgery in morbidly obese subjects.” J Clin Endocrinol Metab 91: 1735-1740 (2006)

6. Laferrere B, Teixeira J, McGinty J, Tran H, Egger JR, Colarusso A, Kovack B, Bawa B, Koshy N, Lee H, and Yapp K. “Effect of weight loss by gastric bypass surgery versus hypocaloric diet on glucose and incretin levels in patients with type 2 diabetes.” J Clin Endocrinol Metab 93: 2479-2485 (2008)

7. le Roux CW, Welbourn R, Werling M, Osborne A, Kokkinos A, Laurenius A, Lonroth H, Fandriks L, Ghatei MA; Bloom SR. “Gut hormones as mediators of appetite and weight loss after Roux-en-Y gastric bypass. Ann Surg 246: 780-785 (2007)

8. White S, Brooks E, Jurikova L, and Stubbs RS. “Long-term outcomes after gastric bypass.” Obes Surg 15: 155-163 (2005)

9. Dansinger ML, Gleason JA, Griffith JL, Selker HP, and Schaefer EJ “Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction: a randomized trial.” JAMA 293: 43-53 (2005)

10. Gardner CD, Kiazand A, Alhassan S, Kim S, Stafford RS, Balise RR, Kraemer HC, and King AC. “Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: the A TO Z Weight Loss Study: a randomized trial.” JAMA 297: 969-977 (2007)

11. Pawlak DB, Kushner JA, and Ludwig DS. “Effects of dietary glycaemic index on adiposity, glucose homoeostasis, and plasma lipids in animals.” Lancet 364: 778-785 (2004)

12. Ebbeling CB, Leidig MM, Feldman HA, Lovesky MM, and Ludwig DS. “Effects of a low-glycemic load vs low-fat diet in obese young adults: a randomized trial.” JAMA 297: 2092-2102 (2007)

Nothing contained in this blog is intended to be instructional for medial diagnosis or treatment. If you have a medical concern or issue, please consult your personal physician immediately.