Let's Stop Dying, OK?

Researchers from the Harvard School of Public Health, the University of Toronto and the Institute for Health Metrics and Evaluation at the University of Washington have just published the most comprehensive study ever done about how diet, lifestyle and metabolic risk factors for chronic disease contribute to mortality in the U.S.

Want to know what they found?

Here are some of the highlights. Remember, these are the numbers of preventable-repeat preventable- deaths each year in the U.S. directly caused by the following individual risk factors.

Get ready to be stunned.

• Low intake of dietary poly-unsaturated fatty acids: 15,000 deaths
  

• Low intake of fruits and vegetables: 58,000 deaths
  

• Alcohol use: 64,000 deaths. (Note: because moderate drinking reduces the risk of heart disease, stroke and diabetes, alcohol use actually prevented 26,000 deaths, but these deaths were outweighed by the 90,000 alcohol-related deaths from traffic, violence, cancer and other diseases. Net loss, 64,000!)
  

• High intake of trans-fatty acids: 82,000
  

• Low intake of omega-3 fats: 84,000 (we'll be talking a lot more about this in the future!)
  

• High blood sugar: 190,000
  

• Sedentary lifestyle: 191,000
  

• Overweight/ obesity: 216,000
  

And the winner is...

Smoking: 467,000

These figures speak for themselves. I'm particularly stunned by the number of deaths specifically related to high blood sugar (!) and to lack of omega-3's, but all the numbers are sobering.

Now consider this: In another one of the largest ongoing studies of diet and health ever undertaken- the Nurses Health Study- it was found that five behaviors- five- could reduce the risk of heart disease by a whopping 83%. That percentage is higher than any drug has ever performed in the history of the world.

Ready for the five simple behaviors?

1. maintain a healthy weight
   
2. eat a Mediterranean diet (eat fish, omega-3's)
   
3. exercise every day
   
4. don't smoke
   
5. drink alcohol in moderation (if you drink it at all)
   

These same five behaviors will keep an awful lot of people from being swallowed up by the "health care" system, which is- let's be honest- really "sickness care"

Five simple behaviors.

It sure beats becoming a statistic.

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Fat is the New Normal

Retailers would like to help us remain in a state of denial about our ever expanding waistlines.

What?

It's simple, actually. We don't like facing up to the fact that we're becoming fatter by the minute, and most of us don't particularly like buying "fat clothes". We'd prefer not to notice that those size 8 dresses that used to fit no longer do, or that when we try on those 32" waist jeans that used to fit so well, they now feel like they were made for just one of our legs.

Retailers noticed and they have a solution.

They changed the sizes.

"In recent years", writes Elizabeth Landau on CNN.com, "brands from the luxury names to the mass retail chains have scaled down the size labels on their clothing". "You may actually be a size 14, and, according to whatever particular store you're in, you come out a size 10" says Natalie Nixon, associate professor of fashion industry management at Philadelphia University.

Why?

Simple. It makes the consumer- you and me- feel good.

Participants in the National Health and Nutrition Examination Survey for 1988-1994 and participants in the survey for 1999-2004 were asked to identify themselves as "underweight", "about right" or "overweight"; their answers were compared with the participants actual BMI, a measure of health risks associated with weight. (Calculate your BMI.)

Not surprisingly, the BMI of the general population increased from the early survey period to the later survey period, a good indication that as a population we're getting fatter. (No surprise there.) But the probability of people describing themselves as overweight decreased in the later survey. In other words, folks were significantly less likely to identify themselves as overweight even while they were packing on the pounds.

"Fat" is the new "normal".

Interestingly, women tended to have a slightly more realistic perception of themselves, but this may not reflect "healthy body image" campaigns. Rather, according to physician nutrition specialist Dr. Melina Jampolis, it's the relative increase in weight of the general population that makes people with high BMI feel more normal.

But feeling normal while being overweight- which seems to be the trend- may decrease a person's motivation to lose weight in the first place. And retailers subtly changing the size so that you don't "notice" that you're now a couple sizes larger than you were a few years ago, isn't exactly a good reality check. In fact, it helps keep everyone in denial. It's kind of like grading on a curve in school- if everyone in the class is getting 5 out of 10 questions wrong, the person scoring 6 right gets an A.

When it comes to weight, this kind of thinking doesn't do anyone any good. Smoking "only" a pack a day isn't any less of a health risk just because everyone around you is smoking 2 packs!

Weight loss may be one of the most challenging undertakings most of us can think of, but daunting or not, it's one of the best things we can do for our health, our well-being, our energy and our longevity.

The problem is, most of us see "dieting" only in terms of calories. Changing your lifestyle choices is a much deeper, more permanent (and more profoundly meaningful) enterprise, and it's about a lot more than just gritting your teeth and pushing away that second portion of dessert.

That's one reason why I designed Diet Boot Camp to be about much more than food. It's about believing in yourself, bucking the system, breaking the glass ceiling of your own expectations, and ultimately about transformation. People who just follow a "diet" for a while often don't do very well long term.

People who pursue strategies to improve their health, energy, and well-being are doing something a lot more than just "dieting"- they're changing their lives.

That's what Diet Boot Camp is about; creating the life you love in a body you love too.

The Real Health Care Reform Program

It's starting to happen.

Slowly, a growing number of voices from establishment medicine are beginning to sound a different- and much overdue- theme in their writings on the health care crisis.

They're starting to talk about- wait for it- prevention.

What's gotten lost in all the shouting in Congress about the costs of universal health care and the costs of revamping the existing (and quite broken) system, is this simple message: untold millions could be saved by keeping people out of the damn system in the first place.

About which, let me just say two words: Diabetes and Obesity.

Writing in the June 23 edition of the Wall Street Journal, Mark Sklar, MD, writes: "We have unparalleled levels of obesity in our country. If we could prevent even a small percentage of people from becoming obese and developing these conditions, the costs of health care could go down far enough to cover everyone's insurance". Sklar recommends incentive programs to encourage healthy eating and exercise. First step: Ban vending machines and fast food from our schools. (Good luck with that one, but at least he's talking about it!)

"It's really stunning how the percentages for type 2 diabetes are going up in younger and younger Americans. Clearly, diabetes is following obesity, and both have huge ramifications on long-term health," says Siri Atma Greeley, a pediatric endocrinologist at the University of Chicago Medical Center.

"The health insurance system is just horrible for these kids as they age. They get kicked out of their cozy pediatric health care systems, knocked off their parents' health plans, then stop care and suffer the consequences," says Rebecca Lipton, associate professor in pediatric endocrinology at the University of Chicago. "We are already seeing some 20- and 25-year-old kids now on dialysis for kidney failure. It's chilling,"

Indeed. And this might just be the perfect teaching moment. We're all learning (painfully) about what happens when you overspend, overcharge, take an "interest only" mortgage and hope for the best later on. Now it's time to apply those economic lessons to the way we eat and the way we live.

No one said it would be easy, but it's doable. Both diabetes and obesity can be largely prevented and their staggering costs- physically and financially- can be substantially reduced.

How?

We need to do exactly what we're being forced to do with spending: Cut back.

It's really not that hard- and even if it is, so what? We've lived under the illusion that we can have whatever we want and eat whatever we want and folks, it was a big, fat, ugly lie. We spent on our credit cards and worried about the bills later, even though most of what we pay is interest on a principle that never seems to decrease and we've been doing the exact same thing with our health.

And forgive me for ranting, but I'm tired of hearing about "deprivation" as if having to turn down a Krispy Kreme is in the same class as poverty, hunger, or living on $2 a day (which is what half the world does).

Get over it.

It's time for some tough love. You're not deprived if you can't eat all the chocolate and cake and crappy cereals and Olive Garden sized portions of pasta and supersized fries you want.

I don't call that deprived-- I call it smart.

You can start your own health care reform program right now by following these four simple rules:

• Take your desired weight, multiply by 10 and eat that number of calories a day. (You can add a couple hundred if you exercise at least 1/2 an hour on that same day). And no, you won't starve.
  


• Do something that gets your heart rate pumping for at least 30 minutes a day
  


• Take omega 3 fatty acids.
  


• Don't smoke.
  

That may not keep everyone alive out of the health care system, but it'll sure make a profound difference in the amount of time you spend there.

Omega-3's and Obesity

I've been preaching about the benefits of Omega-3 fatty acids for so long I'm hoarse. But up to now, there hasn't been much research on omega-3's and obesity. We know for a fact that omega 3's benefit the heart and the brain. But might they also be helpful in a weight loss program?

Off the record, a number of top trainers and nutritionists have been recommending omega-3's for their overweight clients for years. Why? Every overweight person has some degree of inflammation and omega-3's are anti-inflammatory. Many health professionals suspect that lowering inflammation may make weight loss easier- they just haven't been able to prove it yet in a study.

Now new research seems to confirm what we've long suspected. Spanish researchers found that animals fed omega-3s deposited significantly less fat in their fat tissue and livers, and had much lower production of inflammatory substances. This suggests that increased consumption of omega-3s by obese humans might discourage fat gain and promote healthier fat tissue and liver metabolism.

Another study from Spain, Ireland and Iceland found that higher omega-3 intakes by obese individuals on a weight-loss diet might help control their appetite and satiety, promote weight loss and reduce the likelihood of developing insulin resistance.

Fish oil is the second most important supplement besides a good multi-vitamin. Everyone should be taking it! If fish oil is not already part of your daily routine I recommend Barlean's High Potency Fresh Catch Fish Oil.

New Research: Vitamin D May Lower Heart Disease Risk

Medical researchers are discovering a greater relationship between heart disease and vitamin D -- a nutrient already linked to reducing certain cancers.

Studies announced Wednesday at an American Heart Association's conference on cardiovascular health showed an increased association between people with high levels of vitamin D and a lower risk of heart disease.

Adolescents in particular could face long-term implications if they don't get enough of the vitamin, which can be absorbed through exposure to the sun and is found in certain fishes and in popular fortified foods, including milk and cereal.

One study found that American teens with low levels of vitamin D in their blood were almost four times more likely to have metabolic syndrome, a cluster of heart disease risk factors such as high blood pressure and abdominal fat.

"If you have other risk factors like obesity, you should be hyper-vigilant," said Jared Reis, a post-doctoral research fellow at The Johns Hopkins University School of Public Health in Baltimore. His study, presented at the conference at the Innisbrook Resort, looked at health data of more than 3,500 American teens from 2001-2004.

Although cardiovascular research about the nutrient is still evolving, previous studies have linked vitamin D intake to lower risks of colon, prostate and breast cancers, according to the National Institutes of Health Office of Dietary Supplements. Together with calcium, it also has been historically used to supplement bone health.

This news comes at a time when Americans appear to be decreasing their vitamin D intake. The percentage of Americans deficient in the nutrient increased to 9.2 percent in 2005-06, from 2.6 percent in 1988-94, said researcher Sandy Saintonge of the New York Hospital Queens.

If you aren't taking vitamin D I recommend at least 1000 IUs daily, preferably 2000IUs. Carlson's Vitamin D is cheap ($5.50) and easy to take, so why wouldn't you?

(Acknowledgments: McClatchy-Tribune Information Services and Mary Shedden of the Tampa Tribune)

Sugar as a Health Food?

Sugar's about to show up on food labels, all dressed up as a new "natural ingredient" and a better alternative to the demon d'jour, high-fructose corn syrup.

Never let it be said that there are no "second acts" in the marketing of junk food.

OK, in case you haven't been paying attention, high-fructose corn syrup has gotten quite a whipping in the press. The Corn Refiners Association tried fighting back, most notably with a series of commercial showing a clueless mother unable to explain why the stuff was so "bad", but even the best PR campaign wasn't able to put out the fire. And the coup d'grace was sounded recently by Michelle Obama who declared any product with high-fructose corn syrup to be off-limits at the White House.

So now sugar- plain old white, table sugar, the poor little guy that got displaced by HFCS- is ready for its reinvention, this time as the "natural" healthy alternative to HFCS.

Oh, brother.

Let's recap for a moment. Sugar is one part glucose one part fructose (50/50).. High fructose corn syrup is very close to the same formula, marginally higher in fructose- 55% fructose, 45% glucose- but probably not enough to make that much difference (or at least that's what the proponents of HFCS claim).

But the point is moot and the argument about which is "better" diverts our attention from the real problem.

Which is this: The more damaging half of this dastardly duo of glucose and fructose- regardless of whether it occurs in table sugar or HFCS- is clearly fructose. Numerous studies have shown it raises insulin resistance, raises triglycerides in the bloodstream and contributes to fatty liver disease. Pure refined fructose is bad news, whether it comes from HFCS or from sugar.

The big problem with HFCS is the fact that it's so cheap and widely available that it's now in products that were never sweetened before. And that fact that it's so cheap means that manufacturers can use a ton of it, sweetening everything in sight. The result is that we now consume more fructose than we ever did when manufacturers used plain old sugar.

Going back to "natural" (give me a break) white sugar accomplishes exactly nothing. Refined fructose is metabolic poison, and whether we get it from the old fashioned sugar or the cheap and abundant HFCS matters not a whit. We're eating too much of the stuff.

And less there be any confusion let me add that I'm quite aware that fructose is found naturally in fruits. But fructose in fruits- surrounded by fiber, vitamins, phytochemicals and other good stuff- is a very different "animal" than refined fructose, as different as an animal's fur is from a fur coat in the store window.

You don't need to avoid fructose when it occurs (in small amounts) in whole foods.

When it occurs in refined sweeteners- be they "natural" sugar or high-fructose corn syrup- run the other way.

Gastric Bypass Patients Need Nutritional Supplements

If you're contemplating gastric bypass- or if you've already had it- you'd be wise to bone up on your nutritional supplements. A recent review of all the literature on bariatric surgery found that of all the surgical procedures used to reduce weight, gastric bypass resulted in the most serious post-surgical nutritional deficiencies. The authors conclude that nutritional supplementation is absolutely necessary.

The most common micronutrients found to be deficient were:

• vitamin B12
  
• calcium
  
• vitamin D
  
• thiamine (vitamin B1)
  
• folic acid
  
• iron
  
• zinc
  
• magnesium
  

Gastric bypass is the most popular weight loss surgery in America but it is a double edged sword. While it can reduce some of the risks associated with obesity, it also presents a whole new set of health challenges, and is hardly without side effects or complications including blood clots, leaking, hernia and a fairly high rate of death (1 per 200-300 surgeries). It's not a decision that should be made lightly.

Since you'll have to eat very differently after the surgery, why not try eating that way first? Reduce calories to target weight times 10, trim your nutritional budget of all "non-essential" items (like processed carbs, sugar, soda, and junk foods) and fill your plate with protein and vegetables. You might be surprised at the results!

And if you do have the surgery- or if you've already had it- make sure you're supplementing with vitamins, omega-3 fats and that every calorie you do consume gives you the most nutritional bang for the buck.

Overeating Triggers Overeating

Want a terrific example of the proverbial "vicious circle" when it comes to diet?

Check this out:

Overeating can actually stimulate a metabolic response in the brain that induces cravings to eat more. The result? A vicious cycle of elevated calorie consumption that can lead to obesity, diabetes and insulin resistance.

We've long known that inflammation is a huge part of every degenerative disease from Alzheimer's to heart disease, and it's a big part of obesity as well.

Researchers at the University of Wisconsin-Madison and University of California-San Diego found that overeating can induce inflammatory responses that underlie Type ll Diabetes and obesity.

Here's how it works. There's a structure in your brain called the hypothalamus which is like the command center for regulating appetite, feeding behavior, energy and body-weight balance. And there's a hormone in the body called leptin which has a lot to do with regulating appetite. Leptin talks to the hypothalamus, but when communication lines are down and the hypothalamus doesn't get the message that "we don't need any more food", the hypothalamus can promote or induce either obesity or type ll Diabetes (or both).

Overeating turns on a (normally inactive) protein in the hypothalamus that screws up the communication that would normally keep obesity and associated metabolic problems at bay. When you eat "normally", this protein keeps its mouth shut. When you overeat, the protein acts like a drunk at a Karaoke bar.

So what's the big news? We've known that eating too much makes you fat since forever.

The news is that it's not just that excess calories go right to your butt and thighs. That would be bad enough. But those excess calories actually upset and inflame metabolic processes that underlie disease.

There's a Confucian-inspired adage used by the long-lived healthy people in Okinawa: Hara hachi bu.

It means- eat till you're 80% full.

In other words, push away from the table before you're stuffed. You won't get fat, you might just live longer, and you'll probably protect yourself from some really nasty metabolic consequences.

Atkins Induction Diet improves Glycemic Control in Diabetics

Diabetes is a disease of uncontrolled sugar. In a nutshell, uncontrolled sugar is also a huge contributing factor to obesity and heart disease. When your blood sugar goes too high, insulin comes in to escort that extra blood sugar into the cells where it can be burned for energy. But if insulin doesn't work effectively, you wind up with too much blood sugar and high levels of insulin, and you're on your way to big health problems down the road.

The technical name for this ability of the body to regulate sugar effectively and efficiently is glycemic control.

So what's the number one thing that raises blood sugar anyway? Clearly it's carbohydrates. And study after study has shown that low-carb diets improve the ability of the body to effectively deal with sugar.

Previous research has shown that a low-glycemic diet (i.e. one high in beans, lentils and breads made with flaxseeds) does much better at managing glycemic control for Type ll diabetes than the "traditional" high fiber diet based on whole grain breads and breakfast cereals (which are often loaded with extra sugar).

Now a new study shows that when it comes to controlling blood sugar, the Atkins Induction phase program does even better.

Eric Westman, MD and his research team put 84 community volunteers with with obesity and type 2 diabetes on one of two diets- the very-low carb Atkins Induction Phase Diet or a low-glycemic, reduced calorie diet. After 6 months, there was improvement in both groups in glycemic control. But the Atkins Induction group improved more.

The main measure of improvement was a blood test called hemoglobin A1c, which is a kind of "Rolls Royce" of blood sugar measurement. While blood sugar levels at any given time fluctuate, Hemoglobin A1c gives us a much more realistic reading of the overall effectiveness of blood sugar control over an extended period of time. Since red blood cells basically live for about 3 months before dying, when sugar sticks to these cells it's possible to tell just how much sugar has been around for the past three months.

Both diets- Atkins Induction and low-glycemic- improved Hemoglobin A1c as well as fasting glucose, fasting insulin and even weight loss. But the Atkins Induction diet did slightly better on all four counts.

Both groups were also able to reduce their diabetic medication. But in patients taking insulin, the effects of the Atkins Induction diet were really quite powerful. Participants taking from 40-90 units of insulin before the study were able to eliminate their insulin use after starting the Atkins Induction Diet, sometimes so quickly that the study researchers had to issue the warning that subjects with type 2 diabetes who are unable to adjust their own medication shouldn't make these dietary changes without close medical supervision!

Does this study mean that an Induction diet is preferable to a low-glycemic diet, which in other studies has been shown to be very useful for glycemic control. No. "A low-carbohydrate, (Atkins Induction) diet combines two approaches that, on their own, improve blood glucose control: weight loss and a reduced glycemic index diet", wrote the researchers. Because low-glycemic diets typically contain from 40-60% of calories from carbohydrate, it's possible that the beneficial effect of low-glycemic diets could be augmented even further by the reduction of the absolute amount of carbs- or by a reduction in calories", said Dr. Westman.

Obesity, Pleasure and Addiction

Obese people anticipate enjoying food more than thin people do. But, according to a new brain imaging study, they actually enjoy it less.

For a long time there's been emerging research showing that there's a brain chemistry component to overeating. Studies by Gene-Jack Wang and others have demonstrated for example that obese subjects have fewer dopamine D2 receptors, meaning they are less "sensitive" to reward, a finding that is similar to what's found in drug addicts. It's as if the pleasure circuits of the brain are "hijacked".

"This makes sense because eating, like other activities regulated by dopamine reward circuits, is a highly reinforcing behavior. The behavior of overeating in obese subjects shares similarities with the compulsive use of drugs in addicted subjects", says Dr. Wang.

Dopamine is clearly involved in eating behavior, even for people who aren't obese. Smelling, seeing, and talking about food -- even without the pleasure of eating it -- increases brain dopamine in non-obese, food-deprived subjects. "This provides evidence of an involvement of dopamine in the motivational behaviors that drive food intake, independent of the pleasure of eating the food" says Dr. Wang.

The new research by Eric Stice, PhD, of the Oregon Research Institute shows that obese people anticipate enjoying food more than lean people do- but when they actually eat it, they enjoy it less.

The researchers showed women subjects two pictures- one of a chocolate milkshake, one of a glass of water. The heavier the woman, the more active the "pleasure circuit" in the brain.

But get this- once the women actually tasted the chocolate milkshake, the heavier ones showed less activity in their brains' pleasure centers than the leaner ones.

Food is one of the many stimuli in our lives that release dopamine, a neurotransmitter associated with pleasure- specifically, the anticipation of pleasure. Think about the time you went on a first date with someone you had a crush on- that rush of pleasure and excitement and anticipation was coming from (you guessed it)... dopamine!

One addiction researcher has wisely called dopamine the "gotta have it!" neurotransmitter, while serotonin is the "Ah! Relax! Got it!" neurotransmitter.

Some people have a variant gene that dulls dopamine responses-these folks are more at risk for being obese (and possibly more at risk for addictions in general). Even if they're not obese, they seem to get less pleasure from eating - which puts them at greater risk of compensating by eating more, possibly in an unconscious attempt to increase dopamine and produce pleasure.

So is the take-home point here that obesity and overeating are "genetic"? No. But it does mean that there are powerful brain circuits involved in reward that can make you more at risk for overeating.

You don't need "genetic testing" on this one. Some proactive, empowering actions can help you combat even a genetic propensity to overeat. Find pleasure in as many things as possible, "spread it around" so that you have a repertoire of pleasurable activities (hopefully non-destructive ones!) and take care of your emotional and spiritual needs as much as possible.

And take a stand for your health. Your genes are not destiny.

Remember, genetics loads the gun. But environment pulls the trigger.