Exercise, Part 2: The Fountain of Youth and Other Metabolic Effects

Part 1 of the Exercise series focused on how regular physical activity prevented or postponed death. Onward now to other benefits.

Waist Management

Where does the fat go when you lose weight dieting? Chemical reactions convert it to energy, water, and carbon dioxide, which weigh less than the fat. Most of your energy supply is used to fuel basic life-maintaining physiologic processes at rest, referred to as resting or basal metabolism. Basal metabolic rate (BMR) is expressed as calories per kilogram of body weight per hour.

The major determinants of BMR are age, sex, and the body’s relative proportions of muscle and fat. Heredity plays a lesser role. Energy not used for basal metabolism is either stored as fat or converted by the muscles to physical activity. Most of us use about 70 percent of our energy supply for basal metabolism and 30 percent for physical activity. Those who exercise regularly and vigorously may expend 40–60 percent of their calorie intake doing physical activity. Excess energy not used in resting metabolism or physical activity is stored as fat.

Insulin, remember, is the main hormone converting that excess energy into fat; and carbohydrates are the major cause of insulin release by the pancreas.

To some extent, overweight and obesity result from an imbalance between energy intake (food) and expenditure (exercise and basal metabolism). Excessive carbohydrate consumption in particular drives the imbalance towards overweight, via insulin’s fat-storing properties.

In terms of losing weight, the most important metabolic effect of exercise is that it turns fat into weightless energy. We see that weekly on TV’s “Biggest Loser” show; participants exercise a huge amount. Please be aware that conditions set up for the show are totally unrealistic for the vast majority of people.

Physical activity alone as a weight-loss method isn’t very effective. But there are several other reasons to recommend exercise to those wishing to lose weight. Exercise counteracts the decrease in basal metabolic rate seen with calorie-restricted diets. In some folks, exercise temporarily reduces appetite (but others note the opposite effect). While caloric restriction during dieting can diminish your sense of energy and vitality, exercise typically does the opposite. Many dieters, especially those on low-calorie poorly designed diets, lose lean tissue (such as muscle and water) in addition to fat. This isn’t desirable over the long run. Exercise counteracts the tendency to lose muscle mass while nevertheless modestly facilitating fat loss.

How much does exercise contribute to most successful weight-loss efforts? Only about 10 percent on average. The other 90 percent is from food restriction.

Fountain of Youth

Regular exercise is a demonstrable “fountain of youth.” Peak aerobic power (or fitness) naturally diminishes by 50 percent between young adulthood and age 65. In other words, as age advances even a light physical task becomes fatiguing if it is sustained over time. By the age of 75 or 80, many of us depend on others for help with the ordinary tasks of daily living, such as housecleaning and grocery shopping. Regular exercise increases fitness (aerobic power) by 15–20 percent in middle-aged and older men and women, the equivalent of a 10–20 year reduction in biological age! This prolongation of self-sufficiency improves quality of life.

Heart Health

Exercise helps control multiple cardiac (heart attack) risk factors: obesity, high cholesterol, elevated blood pressure, high triglycerides, and diabetes. Regular aerobic activity tends to lower LDL cholesterol, the “bad cholesterol.” Jogging 10 or 12 miles per week, or the equivalent amount of other exercise, increases HDL cholesterol (“good cholesterol”) substantially. Exercise increases heart muscle efficiency and blood flow to the heart. For the person who has already had a heart attack, regular physical activity decreases the incidence of fatal recurrence by 20–30 percent and adds an extra two or three years of life, on average.

Effect on Diabetes

Eighty-five percent of type 2 diabetics are overweight or obese. It’s not just a random association. Obesity contributes heavily to most cases of type 2 diabetes, particularly in those predisposed by heredity. Insulin is the key that allows bloodstream sugar (glucose) into cells for utilization as energy, thus keeping blood sugar from reaching dangerously high levels. Overweight bodies produce plenty of insulin, often more than average. The problem in overweight diabetics is that the cells are no longer sensitive to insulin’s effect. Weight loss and exercise independently return insulin sensitivity towards normal. Many diabetics can improve their condition through sensible exercise and weight management.

Miscellaneous Benefits

In case you need more reasons to start or keep exercising, consider the following additional benefits: 1) enhanced immune function, 2) stronger bones, 3) preservation and improvement of flexibility, 4) lower blood pressure by 8–10 points, 5) diminished premenstrual bloating, breast tenderness, and mood changes, 6) reduced incidence of dementia, 7) less trouble with constipation, 7) better ability to handle stress, 8) less trouble with insomnia, 9) improved self-esteem, 10) enhanced sense of well-being, with less anxiety and depression, 11) higher perceived level of energy, and 12) prevention of weight regain.

People who lose fat weight but regain it cite lack of exercise as one explanation. One scientific study by S. Kayman and associates looked at people who dropped 20 percent or more of their total weight, and the role of exercise in maintaining that loss. Two years after the initial weight loss, 90 percent of the successful loss-maintainers reported exercising regularly. Of those who regained their weight, only 34 percent were exercising.

 Part 3 of this series gets into specific exercise recommendations.

Steve Parker, M.D.

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Exercise, Part 1: Exercise Postpones Death

Earlier this month, many folks made New Years’ resolutions to start exercising in conjunction with their other resolution to lose excess weight. I’ve got bad news for them.

Exercise is overrated as a pathway to major weight loss.

Sure, a physically inactive young man with only five or 10 pounds (2 to 4 kg) to lose might be able to do it simply by starting an exercise program. That doesn’t work nearly as well for women. The problem is that exercise stimulates appetite, so any calories burned by exercise tend to be counteracted by increased food consumption.

"Should I go with aerobic or strength training....?"

On the other hand, exercise is particularly important for diabetics and prediabetics in two respects: 1) it helps in avoidance of overweight, especially after weight loss, and 2) it helps control blood sugar levels by improving insulin resistance, perhaps even bypassing it.

Even if it doesn’t help much with weight loss, regular physical activity has myriad general health benefits. First, let’s look at its effect on death rates.   

EXERCISE PREVENTS DEATH

As many as 250,000 deaths per year in the United States (approximately 12% of the total) are attributable to a lack of regular physical activity. We know now that regular physical activity can prevent a significant number of these deaths.

Exercise induces metabolic changes that lessen the impact of, or prevent altogether, several major illnesses, such as high blood pressure, coronary artery disease, diabetes, and obesity. There are also psychological benefits. Even if you’re just interested in looking better, awareness of exercise’s other advantages can be motivational.

Exercise is defined as planned, structured, and repetitive bodily movement done to improve or maintain physical fitness.

Physical fitness is a set of attributes that relate to your ability to perform physical activity. These attributes include resting heart rate, blood pressure at rest and during exercise, lung capacity, body composition (weight in relation to height, percentage of body fat and muscle, bone structure), and aerobic power.

Aerobic power takes some explanation. Muscles perform their work by contracting, which shortens the muscles, pulling on attached tendons or bones. The resultant movement is physical activity. Muscle contraction requires energy, which is obtained from chemical reactions that use oxygen. Oxygen from the air we breathe is delivered to muscle tissue by the lungs, heart, and blood vessels. The ability of the cardiopulmonary system to transport oxygen from the atmosphere to the working muscles is called maximal oxygen uptake, or aerobic power. It’s the primary factor limiting performance of muscular activity.

Aerobic power is commonly measured by having a person perform progressively more difficult exercise on a treadmill or bicycle to the point of exhaustion. The treadmill test starts at a walking pace and gets faster and steeper every few minutes. The longer the subject can last on the treadmill, the greater his aerobic power. A large aerobic power is one of the most reliable indicators of good physical fitness. It’s cultivated through consistent, repetitive physical activity.

Physical Fitness Effect on Death Rates

Regular physical activity postpones death.

Higher levels of physical fitness are linked to lower rates of death primarily from cancer and cardiovascular disease (e.g., heart attacks and stroke). What’s more, moving from a lower to a higher level of fitness also prolongs life, even for people over 60.

Part 2 of this series will cover all the other health benefits of exercise. Part 3 will outline specific exercise recommendations, such as the type and duration of activity.

Steve Parker, M.D.

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Famous or Successful People with Diabetes

The “Nursing Schools” website has posted a list of 50 successful people with diabetes you may recognize. One is Ray Kroc, founder of McDonald’s restaurants. Just helps to show that diabetes doesn’t have to be a death sentence.
The link: http://www.nursingschools.net/blog/2011/01/50-famous-successful-people-who-are-diabetic/

-Steve

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ADA Weight-Loss Guidelines for 2011

Earlier this month the American Diabetes Association published its Standards of Care in Diabetes—2011

The ADA recommends weight loss for all overweight diabetics.

For weight loss, either low-carbohydrate [under 130 g/day], low-fat calorie-restricted, or Mediterranean diets may be effective in the short-term (up to two years).  For those on low-carb diets, monitor lipids, kidney function, and protein consumption, and adjust diabetic drugs as needed…The optimal macronutrient composition of weight loss diets has not been established. [Macronutients are carbohydrates, proteins, and fats.]

Until three years ago, the ADA recommended against carbohydrate-restricted diets for overweight diabetics.  In January, 2008, their position statement noted that such diets may be effective for up to one year.  My recollection is that their 2010 guidelines also said “up to one year” and didn’t mention the  Mediterranean diet. 

Progress!

Looks like the timing of my Low-Carb Mediterranean Diet is good.

Steve Parker, M.D.

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Asian Strokes Are Not Same as Western

The higher the consumption of saturated fat, the lower the risk of death from stroke, according to Japanese researchers in a recent American Journal of Clinical Nutrition

Most physicians in the West would have predicted the opposite: saturated fats increase your risk of stroke.  Western physicians tend to think most strokes and heart attacks are caused by the same process, atherosclerosis, and would be aggravated by saturated fat consumption.  We’re learning that ain’t necessarily so.

Most strokes in the Western world are thought to be linked to atherosclerosis (hardening of the arteries) of relatively large arteries. In Japan, most strokes not caused by bleeding in the head are actually lacunar infarctions involving small arteries in the brain, not necessarily involving atherosclerosis

Another major difference between East and West is that saturated fat consumption in Japan is far lower than in the West.

Are you confused yet?

It seems to me that comparing strokes in Japan versus the West is comparing apples to oranges.  The take-away point to me is that we have to be quite wary of generalizing the research results applicable to one culture or ethnic group, to others.

By the way, stroke had been the third leading cause of death in the U.S. for the last 50 years.  It was recently demoted to fourth place by chronic lower respiratory disease.  The traditional Mediterranean diet is one way to reduce your risk of stroke, and the DASH diet works for women.  Keeping your blood pressure under 140/90 is another.  And don’t smoke.

Steve Parker, M.D.

Reference:  Yamagishi, Kazumasa, et al.  Dietary intake of saturated fatty acids and mortality from cardiovascular disease in Japanese: the Japan Collaborative Cohort Study for Evaluation of Cancer Risk Study.  American Journal of Clinical Nutrition, August 4, 2010.  doi: 10.3945/ajcn.2009.29146

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Low-Carb Almond Pound Cake

My son, Paul, and I had a great time making this when he was 11-years-old, around the time he announced he “might be interested in a career as a culinary professional.” This cake was our first joint baking project.

Almond Pound Cake 

2 cups (224 g) almond flour

1 cup (113 g) butter at room temperature     

4 oz (116 g) cream cheese at room temperature

1 cup (28 g) Splenda Granulated No Calorie Sweetener     

6 eggs, medium size (44 g each), at room temperature

1 tsp (5 ml) baking powder   

1 tbsp (15 ml) lemon zest (or 1.5 tsp lemon extract)

1 tsp (5 ml) vanilla extract

 If you can’t find almond flour, make your own by grinding almonds into the consistency of a flour. You can do this in a blender or electric coffee bean grinder.

 Preheat oven to 350 degrees F (175 degrees C).

 Mix the butter, cream cheese, and Splenda with a hand-held or table-top mixer, then beat in the eggs one at a time, mixing thoroughly after each egg. In a separate container, mix the baking powder into the almond flour. Add the almond flour a little at a time into the butter/sour cream bowl, beating as you go. Then mix in vanilla extract and lemon zest. Pour into a 9-inch (22-24 cm) cake pan greased with butter, vegetable oil, or Baker’s Joy Baking Spray, then bake at 350 degrees F for 35-40 mins.

 Nutrient Analysis:

Recipe makes 12 servings. Each serving has 248 calories, 5 g carbohydrate, 1 g fiber, 4 g digestible carbohydrate, 5 g protein, 18 g fat. 27% of calories are from carbohydrate, 9% from protein, 64% from fat.       

Steve Parker, M.D.

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Low-Carb Diets Killing People?

Animal-based low-carb diets are linked to higher death rates, according to a recent study in the Annals of Internal Medicine.  On the other hand, a vegetable-based low-carb diet was associated with a lower mortality rate, especially from cardiovascular disease.

As always, “association is not causation.”

It’s just a matter of time before someone asks me, “Haven’t you heard that low-carb diets cause premature death?”  So I figured I’d better take a close look at the new research by Fung and associates.

It’s pretty weak and unconvincing.  I have little to add to the cautious editorial by William Yancy, Matthew Maciejewski, and Kevin Schulman published in the same issue of Annals.

The study at hand was observational over many years, using data from the massive Nurses’ Health Study and Health Professionals’ Follow-up Study.  To find the putative differences in mortality, the researchers had to compare the participants eating the most extreme diets.  The 80% of study participants eating in between the extremes  were neutral in terms of death rates.

They report that “…the overall low-carbohydrate diet score was only weakly associated with all-cause mortality.”  Furthermore,

These results suggest that the health effects of a low-carbohydrate diet may depend on the type of protein and fat, and a diet that includes mostly vegetable sources of protein and fat is preferable to a diet with mostly animal sources of protein and fat.

In case you’re wondering, all these low-carb diets derived between 35 and 42% of energy (total calories) from carbohydrate, with an average of 37%.  Anecdotally, many committed low-carbers chronically derive 20% of calories form carbohydrate (100 g of carb out of 2,000 calories/day).  The average American eats 250 g of carb daily, 50-60% of total calories.

Yancy et al point out that “Fung and coworkers did not show a clear dose-response relationship in that there was not a clear progression of risk moving up or down the diet deciles.”  If animal proteins and fats are lethal, you’d expect to see some dose-response relationship, with more deaths as animal consumption gradually increases over the deciles.

ResearchBlogging.orgThe Fung study is suggestive but certainly not definitive.  Anyone predisposed to dietarycaution who wants to eat lower-carb might benefit from eating fewer animal sources of protein and fat, and more vegetable sources.  Fung leaves it entirely up to you to figure out how to do that. Compared to an animal-based low-carb diet, the healthier low-carb diet must subsitute more low-carb vegetables and higher-fat plants like nuts, seeds, seed oils and olive oil, and avocadoes, for example.  What are higher-protein plants?  Legumes?

You can see how much protein and fat are in your favorite vegetables at the USDA Nutrient Database.

The gist of Fung’s study dovetails with the health benefits linked to low-meat diets such as traditional Mediterranean and DASH.  On the other hand, if an animal-based low-carb diet helps keep a bad excess weight problem under control, it too may by healthier than the standard American diet.

See the Yancy editorial for a much more detailed and cogent analysis.  As is so often the case, “additional studies are needed.”

Steve Parker, M.D.

Reference: Fung TT, van Dam RM, Hankinson SE, Stampfer M, Willett WC, & Hu FB (2010). Low-carbohydrate diets and all-cause and cause-specific mortality: two cohort studies. Annals of internal medicine, 153 (5), 289-98 PMID: 20820038

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Mediterranean Diet Prevents Middle-Age Weight Gain? Yeah, Right…

Several mainstream media sources recently touted the Mediterranean diet as an effective method for prevention of the expected middle-age weight gain.  Reuters is one source, for example.  Men on the Mediterranean diet gained 2 lb (about a kilogram) less than other men over six years.  Mediterranean-dieting women gained weight too, but a whole 0.77 lb (0.35 kg) less than others.

Big whoop.

The media attention was based on a Spanish study of over 10,000 men and women university graduates over the course of six years.  Average baseline age was 38.  A Mediterranean diet score was calculated based on a food frequency questionnaire given only at the start of the study.  Adherence with a Mediterranean-style diet was judged for each individual as either low, medium, or high.

You’d think this research report would tell you how much weight these folks gained on average over six years, and how manypounds less if one followed the Mediterranean diet.  Think again.  No such luck, which reminds me of one of my favorite aphorisms: “eschew obfuscation.”

I had to do my own calculations based on Table 3.  And I still don’t know how much the average person in this cohort gained over six years.

I am a die-hard Mediterranean diet advocate.  It’s linked to myriad health benefits.  I’d love to believe it prevents middle-age weight gain.  But the results of this study are so modest as to be almost nonexistent.

Steve Parker, M.D.

Reference:  Beunza, J., et al.  Adherence to the Mediterranean diet, long-term weight change, and incident overweight  or obesity: The Seguimiento Universidad de Navarra (SUN) cohortAmerican Journal of Clinical Nutrition.  doi: 10.3945/ajcn.2010.29764

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Mediterranean Diet Prevents Diabetes – Again

Spanish researchers report that the Mediterranean diet reduced the risk of developing diabetes by 50% in middle-aged and older Spaniards, compared with a low-fat diet. 

Over 400 people participated in a trial comparing two Mediterranean diets and a low-fat diet.  Over the course of four years, 10 or 11% of the Mediterraneans developed type 2 diabetes, compared to 18% of the low-fatters.  One of the Mediterranean diets favored olive oil, the other promoted nut consumption.

We’ve seen previously that the Mediterranean diet prevents diabetes—not all cases, of course—in folks who have had a heart attack.  It also reduced the risk of diabetes in younger, generally healthy people in Spain.

So What?

The study at hand is not ground-breaking.  It enhances the body of evidence that the Mediterranean diet is one of the healthiest around.  I suppose another way to look at this study would be to say that the low-fat diet caused diabetes.

Learn how to move your diet in a Mediterranean direction at Oldways or the Advanced Mediterranean Diet website. 

Diabetics and prediabetics should consider the Low-Carb Mediterranean Diet; otherwise look into the Advanced Mediterranean Diet if you need to lose weight.

Steve Parker, M.D.

Reference:  Salas-Salvado, Jordi, et al.  Reduction in the incidence of type 2 diabetes with the Mediterranean diet: Results of the PREDIMED-Reus Nutrition Intervention Randomized Trial.  Diabetes Care, epub ahead of print, October 7, 2010.  doi: 10.2337/dc150-1288

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Abbott Recalls Glucose Test Strips

Abbott is a major supplier of fingerstick blood sugar test strips.  If you use Abbott test strips, be aware that they’ve announced a recall of over 350 million strips because they tend to read falsely low.  Click for details at this Abbott website.

Steve Parker, M.D.

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