Obesity: it is not just about diet and exercise
By Dr. Max Sawaf – Medical director, CosmeSurge
New scientific evidence explains the reasons for the obesity epidemic and what to do about it.
Stress is emerging as a leading cause for obesity. Stress can be external in nature such as long commutes, lack of control over the daily decision making at work, financial pressure, a difficult marriage or a rebellious child. Stress can also be internal in nature such as food intolerance leading to gut inflammation, dental fillings containing mercury, fat around the belly producing inflammatory cytokines or a poor dental hygiene causing gum disease. The toxic air we breathe, pesticide laden vegetables and fruits we eat, meat and dairy products loaded with estrogen we consume, and possible effects of magnetic fields emitted by all kinds of mobiles and other gadgets can all add to oxidative stress.
In order to understand why diets fail, understanding the workings of your metabolism and how stress affects it is necessary. The term ‘Basic Metabolic Rate’ refers to how much your body burns when you are asleep or involved in sedentary activities, which for most is the majority of the time. A small change in metabolism has a huge impact on your weight. Clearly, those who eat loads and do not gain weight have a higher metabolism than someone who eats little but piles on the pounds. So what is it that determines your metabolic rate? 40% of the metabolic rate is determined by the activity of the thyroid hormone and the rest is mainly determined with how much muscle we have with genetics playing a smaller role.
Fat is very light in weight. Think of it like snow. One kilogram of fat fills more than a two liter bottle of Coke but burns only five calories per day, or the equivalent of one olive. One kilogram of muscle is half that size and burns a hundred calories per day or twenty olives. The truth is that all diets succeed in the first few weeks for various reasons, but they all fail for the same reason: more than half of the weight loss in most diets is loss of water and muscle, which will slow down your metabolism. What counts is not how much you weigh but how much extra fat you have. Stop obsessing with the scales, kilograms and weight, and concentrate more on your muscle mass, and the circumference of your waist. After age thirty, we lose 1% of our muscles per year. So by age 63, we would have lost one third of our muscles.
The danger of all diets, especially when they are not balanced in terms of providing enough protein, is that you end up losing so much muscle that when you eventually stop dieting, and all dieters eventually get tired of dieting, the same amount of food will make you gain even more weight since your metabolism is now slower, thanks to the dreaded ‘yo-yo dieting’ mechanism having taken root.
Too often thyroid lab tests that are quoted as “normal” fail to identify the common cases of suboptimal thyroid function also called sub-clinical hypothyroidism. The signs of sub-clinical hypothyroidism include the inability to lose weight, sluggish memory and lack of energy, constipation, dry skin and intolerance to cold. You do not have to have all these symptoms to be diagnosed with this condition. Stress also plays a major role. Stress triggers the release of a hormone from the adrenals to deal with stress called cortisol. Chronic cortisol secretion increases circulating blood sugar and contributes to muscle wasting. Chronic cortisol secretion inhibits the conversion of the less active T4 to the active T3 form of thyroid hormone.
The body produces cortisol hormones to deal with stress and inflammation out of the body’s cholesterol reserves. However, the sex hormones (testosterone in males and progesterone in females) are also produced from cholesterol. Too much stress forces the body to convert most cholesterol to cortisol leaving it deficient in sex hormones. Men end up with less than optimal testosterone levels which contribute to muscle wasting, osteoporosis, heart attacks, decreased memory, joint and muscle aches, depression and fat accumulating around their abdomen. Interesting to note that depressed men do not cry over a psychiatrist shoulder like most women do, but rather experience a lack of energy and a constant state of feeling pissed off.
In women, the increased cortisol production at the expense of progesterone leads to elevated anxiety, fears, bloating and water retention, insomnia and increased pain around their period with increased bleeding. This mental and physical state leads to emotional eating and sweet cravings.
The fat cells that accumulate are not inert. They are active glands that produce hormones such as Leptin which affect our appetite, inflammatory agents that contribute to insulin resistance and diabetes, and cause endothelial arterial damage leading to heart attacks. Fat cells also produce estrogens leading to breast cancer in women, prostate cancer in men and colon cancer in both sexes.
Our body is designed to produce cortisol to deal with immediate dangers such as facing a lion when our ancestors went hunting or being in a near miss car accident today. Our bodies were not designed to deal with chronic stress like the one created by mobiles, emails, 24 hours depressing TV news, and the financial burden created by too many TV ads combined with easy credit. The body is designed to secrete some cortisol to deal with the acute inflammation produced by an animal bite when we went hunting. It is not designed for the chronic inflammation created by an inflamed gut subjected to too much gluten from processed wheat in bread or the indiscriminate use of antibiotics leading to the destruction of the friendly gut bacteria that produces essential vitamins we need to process the food we eat. Chronic inflammation of the vascular endothelium from bathing the body in sugar creates a condition that leads to sugar binding to protein and fat in our brain (glycation). Glycation leads to Alzheimer’s and shrinkage of the memory centers in the brain.
Physicians receive less than five hours of nutritional education throughout their medical schooling. Too many of them are obese and some are even smokers. If they cannot help themselves, how can they help you?
A good weight management program is centered on a team that aims to crack your metabolic code by identifying the above problems and addressing them as opposed to handing you “the diet de jour”. It starts by collecting plenty of information (in my practice at CosmeSurge, you are asked to fill an extensive questionnaire consisting of 1,000 questions and are handed easy to read material to improve your nutritional education and awareness), something that a busy practitioner cannot do in the typical fifteen minute consultation.
The patient is then asked to proceed with the appropriate tests to confirm the physicians clinical impression, using advanced testing such as saliva testing to track cortisol levels throughout the day, genetic testing to identify common mistakes in our DNA that makes us prone to certain cancers, diabetes or heart attacks and urine testing for toxic material in the body such as mercury or lead. A program is then created to suit the individual needs of each patient. We try to avoid as much as possible drugs, in favor of education and awareness based lifestyle changes. We also use therapeutic levels of certain vitamins and supplements to decrease inflammation and cortisol production, elevated insulin, sugar, lipids and blood pressure. These therapeutic levels are not found in a simple multivitamin pill.
Finally, here are the deadliest twenty dieting mistakes people make:
- Drinking sugar-laden drinks, including fresh juices, especially when living in a country with a hot climate. Air conditioning dries up your mucosa so drinking fluids is a must. Nothing crosses your lips without calories or chemicals - except water. So drink up.
- Indulging excessively in alcohol. Alcohol has sorbitol, the fastest sugar that the body can absorb which stimulates insulin secretion followed by uncontrollable hunger. All alcoholic drinks contribute to a ‘beer belly’… not just beer although beer is the worst offender.
- Believing that diet drinks keep you slender: Take a sip and immediately your taste buds become accustomed to sweet products and will demand more sweet tastes. After drinking a diet cola for instance, an apple does not taste so appetizing. Your taste buds then demand apple pie, chocolate or ice cream. But after drinking water an apple is sweet indeed. In addition, the phosphorus in diet drinks ruins your teeth and interferes with calcium absorption in the gut. Caffeine in some diet drinks increases stress levels too. An active ingredient, the artificial sweetener Aspartame, can cause attention deficit in children and certain cancers in rats. Airline pilots are now required to sign a form with their new contracts that they would not use Aspartame. Diet drinks are also loaded with chemicals. Indeed, if ‘Dettol’ does not clear a stain on your kitchen floor, try a diet drink. This idea impressed the heck out of my children.
- Poor sleep habits (The rule of thumb is: If you are sleepy during the day you are not sleeping enough at night). If you do not get enough sleep your body demands more sugar to get the energy it lacks. Staying up late and having a big meal before going to sleep when the metabolism is at its slowest.
- Skipping breakfast because you are not hungry or feeling guilty when you wake up after eating so late and thinking that skipping breakfast reduces caloric intake. Breakfast shifts your metabolism into higher gear.
- Eating too much meat. Change your thinking a bit by making meat the accompaniment to a meal rich in legumes and vegetables; almost a side dish. Stay away from processed meats such as salami or bologna.
- Stuffing yourself at the infamous ‘all-you-can-eat’ buffets and overeating in order to ‘get your money's worth.’
In my view, buffet fare is copious but is rarely delicious, so we keep trying to find something good by trying so many poor tasting dishes.
- Starving all day then binging out of control. You should have three meals and one or two snacks to keep a well charged metabolism.
- Thinking that smoking make you lose weight. In fact it interferes with the ability to exercise and therefore makes you gain weight. People who quit gain an average of three kilograms but are much better off in the long run.
- Stocking juices, chocolates, deserts and nuts supposedly for guests, but eating more of it yourself. You are what you eat. You are what you put in your grocery store card. Read the labels.
- Believing in quick fix and magic pill solutions such as liposuction, obesity surgery, diet pills without understanding the complex factors that we covered in this article.
- Consuming fast foods on a regular basis. Anyone who eats fast food more than once a week is endangering their health and must watch the popular movie ‘Super Size Me’ where the film-maker went on a thirty-day McDonald’s diet, gained thirty pounds and almost died.
- Believing in fad diets: chemical diet, Atkin’s diet, South Beach diet, liquid diets and diets based on blood groups and food allergy tests.
- Watching too much television: sitting still for hours bombarded by food ads and eating while glued to the TV.
- Eating more bread, pasta and potatoes than proteins, lean meats, fruits and vegetables. Use whole-wheat flour.
- Relying on fat and oil to give food a taste instead of spices, garlic, pickles, mustard and onions (the lost art of home cooking should be rediscovered based on the Mediterranean cuisine and the Thai cuisine that are the healthiest and tastiest in the world.)
- Thinking that olive oil is less fattening than other oils or butter. It is as fattening but causes less blocking to the arteries because it is rich with high density fat; so don’t overdo ‘the olive oil thing’.
- Not scheduling exercise as a vital part of your day and week. Leaving exercise up to your mood and available time instead of treating it like an appointment with your doctor. Ignoring weight lifting needed to develop the muscles in our upper body especially by women.
- Hanging around the kitchen: build a career instead, get a job or stay home and work, as opposed to relying on maids, nannies and gardeners.
- Not practicing any religion or paying any attention to spiritual issues, overemphasizing material things and selfishness; a clear recipe for depression and a feeling of alienation and emptiness.
So there you have it. Bypass making the twenty dieting mistakes by reading the above list at least once a month (it is amazing how quickly we forget information) and enjoy life the way you want it: slimmer, healthier and more beautiful. For more tips visit my website at www.cosmesurge.com or read my book “Younger Everyday.”
Let your motto be ‘habits not diets’. New habits are hard to learn. It takes three months to internalize a new habit, so go slow but keep at it. After all your true wealth is your health. I am always amazed at people who fine tune their cars every six months but neglect to fine tune their body and their health.
|
