Category Archives: Uncategorized

Do Heated Buildings Cause Obesity? Does Cold Exposure Prevent It?

diabetic mediterranean diet paleobetic diet, advanced mediterranean diet

Are heated buildings making us fat?

Dr. Stephan Guyenet thinks they might. It’s not so much central heat as it is failing to expose our bodies adequately to temperatures around 60° F (15.6° C) or lower on a regular basis. Here’s a human experiment Dr. G wrote about:

The second study went further, using a longer cold exposure protocol to investigate changes in fat mass among people with low brown fat activity at baseline (4).  Researchers exposed volunteers to 63 F (17 C) air for two hours a day over a six-week period; again I assume they were lightly clothed.  As in the previous study, they observed an increase in brown fat activity with cold training, and they found that calorie expenditure was higher when subjects were in the ‘cold’ air.  After six weeks of training, body fat mass had declined by about 5 percent.  This is despite the fact that all subjects were lean to begin with!

Read the rest.

I thought this study tied in with that one showing an inverse relationship between altitude and obesity. Environmental temperature rises roughly 3° F with every 1,000 feet (305 meters). But the altitude study controlled for (accounted for) temperature, meaning that the temperature had nothing to do with the association.

Somebody’s probably already tried to link environmental temperatures—whether inside the house or out—to obesity rates. Let me know if you find it.

—Steve

Addendum (after a little searching):

A few minutes at Pubmed.gov revealed this 2013 abstract:

Objective: Raised ambient temperatures may result in a negative energy balance characterized by decreased food intake and raised energy expenditure. This study tested whether indoor temperatures above the thermoneutral zone for clothed humans (approx. 23 o C) were associated with a reduced body mass index (BMI). Design and Methods: Participants were 100,152 adults (≥ 16 years) drawn from 13 consecutive annual waves of the nationally representative Health Survey for England (1995 – 2007). Results: BMI levels of those residing in air temperatures above 23 o C were lower than those living in an ambient temperature of under 19 o C (b = -.233, SE =.053, p <.001), in analyses that adjusted for participant age, gender, social class, health and the month/year of assessment. Robustness tests showed that high indoor temperatures were associated with reduced BMI levels in winter and non-winter months and early (1995 – 2000) and later (2001 – 2007) survey waves. Including additional demographic, environmental, and health behavior variables did not diminish the link between high indoor temperatures and reduced BMI. Conclusions: Elevated ambient indoor temperatures are associated with low BMI levels. Further research is needed to establish the potential causal nature of this relationship.

And consider this abstract, probably from the altitude study I mentioned:

http://www.ncbi.nlm.nih.gov/pubmed/23357956

“There was an approximately parabolic relationship between mean annual temperature and obesity, with maximum prevalence in counties with average temperatures near 18 °C [64.4° F].”

I don’t have the full article, but “parabolic” in this context probably means the obesity incidence was highest at 64.4° F, with lower obesity incidence both above and below 64.4°.

Of course, living in a particular environment doesn’t equate to exposing yourself to outdoor temperatures. But it makes sense that someone living in a cold environment will have more cold exposure than someone in a hot climate.

Perhaps 64.4° F is a sweet spot for efficient body temp regulation and energy partitioning. Living at temps significantly above or below that may cost you energy-wise: you expend extra calories maintaining a normal body temperature, tending to result in lower obesity incidence.

2 Comments

Filed under Overweight and Obesity, Uncategorized

Worried About Future Heart Attack? Check Your LDL Cholesterol Particle Number (LDL-P)

…according to Drs. Thomas Dayspring and James Underberg. I don’t know if these guys are right or not. I bet it’s more complicated than simple LDL particle number.

Even if you eat lots of eggs, most of your cholesterol is made by your liver. That's where statin drugs work.

Even if you eat lots of eggs, most of your cholesterol is made by your liver. That’s where statin drugs work.

Most heart attacks (aka myocardial infarctions) do indeed seem to be caused by acute rupture of an atherosclerotic plaque that’s been present for years. Two key questions are:

  1. What causes the plaque?
  2. Why causes them to rupture?

Underberg and Dayspring write:

The only absolute requirement for plaque development is the presence of cholesterol in the artery: although there are additional heart risk factors like smoking, hypertension, obesity, family history, diabetes, kidney disease, etc., none of those need to be present. Unfortunately, measuring cholesterol in the blood, where it cannot cause plaque, until recently has been the standard of risk-testing. That belief was erroneous and we now have much better biomarkers to use for CV risk-assessment. The graveyard and coronary care units are filled with individuals whose pre-death cholesterol levels were perfect. We now understand that the major way cholesterol gets into the arteries is as a passenger, in protein-enwrapped particles, called lipoproteins.

Particle entry into the artery wall is driven by the amount of particles (particle number) not by how much cholesterol they contain. Coronary heart disease is very often found in those with normal total or LDL-cholesterol (LDL-C) levels in the presence of a high LDL particle number (LDL-P). By far, the most common underlying condition that increases LDL particle concentration is insulin resistance, or prediabetes, a state where the body actually resists the action of the sugar controlling hormone insulin. This is the most common scenario where patients have significant heart attack risk with perfectly normal cholesterol levels. The good news is that we can easily fix this, sometimes without medication. The key to understanding how comes with the knowledge that the driving forces are dietary carbohydrates, especially fructose and high-fructose corn syrup. In the past, we’ve often been told that elimination of saturated fats from the diet would help solve the problem. That was bad advice. The fact is that until those predisposed to insulin resistance drastically reduce their carbohydrate intake, sudden deaths from coronary heart disease and the exploding diabetes epidemic will continue to prematurely kill those so afflicted.

***

And for goodness’ sake, if you want to live longer, start reducing the amount of dietary carbohydrates, including bread, potatoes, rice, soda and sweetened beverages (including fruit juices), cereal, candy – the list is large).

Underberg and Dayspring don’t mention don’t mention LDL particle size, such as small/dense and large/fluffy; the former are thought by many to be much more highly atherogenic. Is that outdated?

Whoever figures out the immediate cause of plaque rupture and how to reliably prevent it will win a Nobel Prize in Medicine.

Read the whole enchilada.

Steve Parker, M.D.

About Dayspring and Underberg:

Thomas Dayspring MD, FACP, FNLA   Director of Cardiovascular Education, The Foundation for Health Improvement and Technology, Richmond, VA. Clinical Assistant Professor of Medicine, University of Medicine and Dentistry of New Jersey, New Jersey Medical School.

James Underberg MD, FACP, FNLA   Clinical Assistant Professor of Medicine in the Division of General Internal Medicine at NYU Medical School and the NYU Center for Cardiovascular Disease Prevention . Director of the Bellevue Hospital Primary Care Lipid Management Clinic.

h/t Dr. Axel Sigurdsson

6 Comments

Filed under coronary heart disease, Heart Disease, Uncategorized

Shift Work LInked to Twice the Risk of Diabetes

…according to this paper abstract. It doesn’t say so, but I bet the association is to type 2 diabetes, not type 1.

2 Comments

Filed under Uncategorized

Higher Magnesium Consumption May Reduce Risk of Type 2 Diabetes

…according to an article at Diabetes Care.

Visit the Linus Pauling Institute for dietary sources of magnesium.

Comments Off on Higher Magnesium Consumption May Reduce Risk of Type 2 Diabetes

Filed under Uncategorized

Omega-3 Fatty Acid Supplements Fail to Prevent Dementia

I like fish, but raw whole dead fish leave me cold

Supplementation with omega-3 fatty acids does not help prevent age-related cognitive decline and dementia, according to an article at MedPage Today.

The respected Cochrane organization did a meta-analysis of three pertinent studies done in several countries (Holland, UK, and ?).

The investigators leave open the possibility that longer-term studies—over three years—may show some benefit.

I leave you with a quote from the MedPage Today article:

And while cognitive benefits were not demonstrated in this review, Sydenham and colleagues emphasized that consumption of two servings of fish each week, with one being an oily fish such as salmon or sardines, is widely recommended for overall health benefits.

Steve Parker, M.D.

Reference:
Sydenham E, et al “Omega 3 fatty acid for the prevention of cognitive decline and dementia” Cochrane Database of Systematic Reviews 2012; DOI: 10.1002/14651858.CD005379.pub3.

Comments Off on Omega-3 Fatty Acid Supplements Fail to Prevent Dementia

Filed under Dementia, Uncategorized

Napping Linked to Diabetes and Prediabetes

…in Chinese retirees according to a article at Diabetes Self-Managment. In the study population, 70% of retirees took naps. I’d be surprised if that many U.S. retirees take naps. It’s unclear whether napping causes type 2 diabetes and prediabetes znc whether results apply to non-Chinese ethnic groups.

2 Comments

Filed under Uncategorized

More on Treatment of Gestational Diabetes

…from Amy Campbell at Diabetes Self-Managment. This is the concluding part (III) of her series on GDM. Here’s my favorite part: 

“One of the positive aspects about gestational diabetes (GDM) is that it pretty much disappears after the baby is born. And of course, nothing tops the reward and joy of a happy, healthy baby!”

Comments Off on More on Treatment of Gestational Diabetes

Filed under Uncategorized

Treatment of Gestational Diabetes Mellitus

…more from Amy Campbell at Diabetes Self-Management. This is part 2 her series on gestational diabetes mellitus. 

Comments Off on Treatment of Gestational Diabetes Mellitus

Filed under Uncategorized

What’s “Gestational Diabetes”? No, It’s Not Type 3

You can't tell if she has it just by looking

You can’t tell if she has it just by looking

In a recent article Amy Campbell over at Diabetes Self-Management defines it and goes over risk factors, diagnosis, and why it’s important. I expect a second post on management principles in the near future.

Here’s my review from 2010.

In terms of the best diet, a recent study found no significant outcome differences on a 40% carb diet compared to a standard 55% carb diet. I would have guessed the lower-carb diet would better (see below).

Update Sept. 16, 2013:

Here’s part 2 of Amy’s series, beginning discussion of treatment.

I logged onto UpToDate.com and reviewed treatment briefly. The high points are:

  • See a registered dietitian for counseling.
  • “There is scant level 1 [high quality] evidence to support most aspects of the nutritional prescription for gestational diabetes mellitus.”
  • The authors limit carbohydrates to less than 40% of total calories.
  • Goals of treatment are 1) prevent ketosis, 2) support adequate weight gain of the mother based on body mass index, 3) support the baby, and 4) when drug therapy is needed, use insulin instead of pills.
  • UTD agrees with Amy that frequent blood sugar tests (at least 4x/day) with a home glucose monitor are helpful.

 

Comments Off on What’s “Gestational Diabetes”? No, It’s Not Type 3

Filed under Uncategorized

Metformin Impairs Brain Function In Some Users

 

 

Conquer Diabetes and Prediabetes

Metformin is the most-recommended drug for type 2 diabetes

…according to an article at MedPageToday. I consider this finding preliminary, but definitely something to keep an eye on. We need confirmatory data before taking action. Long-term metformin users should get vitamin B12 levels checked periodically in view of the well-established association of low levels in users. Low B12 impairs cognition and is easily preventable or treated.

1 Comment

Filed under Dementia, Drugs for Diabetes, Uncategorized