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The State of Obesity in America

Or, I liked this too:

Beware the Ides of March

when choosing a title for my March contribution to the NWTC newsletter, What’s Cooking.

This one was a relative quickie, only a couple of hours, but I was pretty revved up after spending three or four hours on an earlier post on another place; however, I did shamelessly plagiarise my good friend, Wm. Shakespeare.

Beware the Ides of March

Perhaps you heard the good news? The obesity rate among adult men and women has plateaued at 35.5% and 35.8%, respectively, when compared to the data from ten years ago. The bad news is that the obesity rate among adult men and women has plateaued over the past ten years, rather than decreasing. Moreover, pediatric obesity has not leveled off; obesity rates for boys (2-19yo) rose to 18.6% from 14% in the past ten years while the rate for girls remained stable at 15%.

Obesity trends have been followed by the CDC since 1960, and the rate remained fairly stable through 1980 at around 10-12% but then increased steadily to their current rates. If you include those overweight, the total incidence of overweight and obese is 68%.

I suppose it’s the old analogy of the cup being half-full, or half-empty. Maybe the US citizenry has reached the apogee of obesity and it’s physiologically impossible to become any fatter. Hmmm…not very likely because I know I could easily become fatter, and in fact have even become so despite the plateauing and my best efforts, and a fifteen pound carrot cake I made last week; but, I am only one out of 300 million, and wasn’t one of the 9000 measured.

Maybe the incidence of obesity is as a baseball thrown mightily skyward, rising steadily, pausing briefly at its point most distant from earth (this would be now) before coasting back to the baseline level of historical normal. I suppose this is possible, but we’ll need to wait ten years to find out. I have my doubts. Something changed after 1975, and I don’t know what it was; if I did, I’d probably be writing this from a private tropical island. There are plenty of suspects that I’ve previously written about; the adenovirus-36 (first isolated from the feces of a diabetic in 1978), High Fructose Corn Syrup (HFCS), which is so ubiquitous in our diet that any attempt to remove it would be akin to trying to remove the argon (0.9%) from the air we breathe, video games, the proliferation and ready availability of high-fat/high carb empty calories, etc., etc.

There have been no new anti-obesity drugs in the past decade because the ones in development proved to be too risky; one was linked to brain tumors in rats, another seemed to cause oral clefts in babies of mothers who took it, and yet another was held up because of a need for a large study about heart risks. There is still no magic pill, and the most effective surgical treatment is a fairly invasive procedure that requires stapling your stomach nearly shut, hooking up a loop of intestine to what remains, and it still requires a lifestyle modification.

Fie, on’t fie! Tis an unweeded garden that grows to seed; things rank and gross in nature possess it merely. Woe unto us! Beware the ides of March, and all that…Perhaps our national epidemic of obesity is as Julius Caesar approaching his demise on the 15th and joking with the seer on the way to the Theatre of Pompey, “The ides of March have come,” to which the seer replied, “Ay, Caesar; but not gone.” Perhaps this leveling off of the obesity rates is our ides of March…to which I would proffer, “Ay, citizenry; but not gone.”

Taking responsibility for your weight and losing weight is no easy matter; and keeping it lost does not become any easier, unless you would be so fortunate as to become infected with a tapeworm that is not of the variety that spreads hematogenously to your liver, lungs and brain. It is not the case that there is a lack of public awareness of the problem of obesity for we are literally surrounded by the evidence if not evidence of it ourselves, speaking as a formerly obese, now merely overweight, adult male. The problem is a lack of education; not that it isn’t there, but that we do not avail ourselves of it; or, if not that, then failing to act upon it.

Pray thee, take heart Citizenry. Take heart you quintessence of dust, you paragon of animals; for you are noble in reason, in apprehension how like a God you are.

 

Paranoia

This is my October contribution to the NWTC Newsletter, What’s Cooking. Since it is October, I saw no harm in a little morbidity.

We’re all gonna die! Someday. That’s an obvious given, a constant, the elemental fact of life with which we will be confronted. One day. That momentous day, in which the age-old question that has plagued mankind subsequent to the onset of sentience is answered—is there a God; is there a spiritual realm in which I will have an awareness of; will I find St. Augustine’s Eternity? The problem is; you won’t be able to tell anyone else the answer. No, that glorious answer belongs to you alone, and all the antecedent arrivals to the hereafter.

The Mayan “Long Count” calendar wraps up a 5,126 year era on 21 December, this year, in a few months, and is supposed by some to mark the end of the world as we know it. How the end comes is anyone’s guess; perhaps it’s a collision with a planet called Nibiru  en route from the star V838 Monoceros;

Monocerotis, from where Nibiru is coming (courtesy of NASA)

or, perhaps it’s a collision with one of a thousand (that we know of) Near Earth Objects (NEO) that are already in the neighborhood. Well, 5000 years doesn’t seem all that significant against the backdrop of a 4.5 billion year-old earth, and the chance of a planetary collision is less likely than me winning the Powerball, and what do a bunch of extinct old Mayan’s know anyway. Therefore, before sinking into the Paranoia of these end-of-the-world scenarios, perhaps we should focus on the more common causes of our material end.

I knew a neurosurgeon where I trained who never drank out of an aluminum can because he thought he’d get Alzheimer’s despite the lack of medical evidence for a causal relationship—but, he is a neurosurgeon, which makes one go…hmmm. After all, Alzheimer’s is the eighth most common cause of death in the U.S., which makes that frosty can of MGD on a blistering summer day behind a fishing pole on a stone beach radiating shimmering waves of heat look less appealing…okay, not really—but then, I’m not a neurosurgeon either. Alright, let’s consider causes  of death one, two and three; heart disease, cancer, and cerebrovascular disease (stroke), which accounted for 60% of all deaths in 2000. Let’s further consider some of the most common causes of cancer; breast, colorectal, endometrial, kidney, ovary, lymphoma, and pancreatic, the first three for which a link to obesity has been firmly established, and the remainder for which there at least seems to be an association.

The sixth most common cause of death is diabetes mellitus of which type II is also strongly associated with obesity. The fifth most common cause of death are unintentional accidents, an example being like going for an innocent bike ride on a beautiful day and suddenly finding yourself launched head-first into space with the overwhelming thought…is this my day? (Ahem…true story—last Memorial Day)

So, it is clear that there’s plenty to be paranoid about, if not fearful, unless you face the thought of death with the equanimity of a saint, unless you are a saint. Not being a saint, I admit to finding myself a few degrees to either side of fearful, depending on the day, my mood, and whether or not I’ve attended church lately. But, if you want to exert a force towards longevity and delay of that momentous day, it is clear where your efforts should be focused—not on avoiding beverages in aluminum cans, but on defeating obesity, given the well-documented link between it and heart disease, diabetes, cancer and stroke; and by only riding your bike on flat grassy fields.

Now all those things seem rather mundane and common (maybe because they are), and much less dramatic than a planet called Nibiru colliding with the earth; but at least they are things we have some control over. Still…I’ve noticed that my exposure to aluminum cans has fallen, and I did notice a particularly bright star in the sky the other night, and I do have a Mossberg 12 gauge leaning in the corner with four shells in the tube, and a pile of nonperishable food in the basement next to my beer-fermenting carboyl for December 21st when the world goes crazy because I’m no saint, and don’t plan on going gentle into that good night.

Mossberg 12 ga.

And you thought I was kidding.

 

The Telomere Age Test

The telomere test for approximation of your biological age has been getting some press lately, so I thought I’d research it a bit and make it the topic for June’s NWTC “What’s Cooking” newsletter.

I’ve been interested in telomeres for a few years because of their relationship to aging.

Telomere Test?

Have you checked your telomeres lately? Do you need to? What the heck are telomeres?

There is a new test that you will soon encounter in the mass market media. The advertisement will read something like, “How much longer will you live,” or maybe, “Find out when you’re supposed to die.” Or, perhaps it will be more positively framed as something like, “Find out your biological age, and how to prolong it.” The test will require a blood sample (possibly saliva) and a payment of about $300, give or take. I’m guessing that the additional information, regarding the prolongation part, will be extra, likely having to do with daily supplements, specialty foods or other allegedly crucial interventions.

The telomere test is a provocative melding of actual science and the various human emotions in orbit around the all-too-real planet of our individual mortality. You have to admit that each of us has, at least to some extent, a morbid curiosity of if not the actual end-of-days, at least our own end-of-day; and, the desire to somehow impact it. This is what some selling the telomere test will promise—a calculation of your biological age, and how to prolong it…by taking vitamins, increasing physical activity, avoiding weight gain or obesity, and correcting insulin resistance (diabetes).

Telomeres are like protective caps on the end of chromosomes, and when the wear out, cells stop dividing and eventually die; so, long telomeres are good and short ones are less good, unless you’re 120 years-old, in which case short ones are expected; or so the argument goes. Of course, it’s not that simple, or predictable for a host of reasons. Let me explain.

You have 23 pairs of chromosomes (46 total) in each cell in your body. Each chromosome is made of your DNA that is specific to you alone in all the universe, unless you’re an identical twin. DeoxyRiboNucleic Acid is kind of like a zipper in that it is made of two matching molecular strands that can unzip and divide into two so that proteins in the cell can assemble new, matching strands so that where there was one, there now are two. This works because each zipper strand has four different kinds of teeth (nucleotide base pairs) call them A, C, G, and T. Each tooth will match up with only one other: G with C, and A with T. And it is the specific sequence of the base pairs that encodes specific genes, like blond hair and blue eyes, or risk of colon and breast cancer. Some genes might have only a few base-pairs, and others, thousands.

23 pairs, 4 different kinds of nucleotides, only two matching pairs—doesn’t sound like big numbers; but, each chromosome can contain up to 10 billion base pairs in a twisted tangled chain. 46 invisible threads in an invisible nucleus in an invisible cell that tell us what we are, if not who. Pretty amazing stuff; and all supposedly arising from a lightning bolt striking a primordial soup long ago; or God—it’s your choice.

The problem with cell division is every time the DNA unzips you lose 30-150 base-pairs off the ends. It’s called “the end replication problem.” Since the telomeres serve as the protective caps, losing a hundred pairs is no big deal—the gene sequences remain safe on the inside as the telomere sacrifices a little bit of itself. The telomeres have about 10,000 base pairs, which comes to 66.6 (10,000/150)  cell divisions before they wear out and die.

The age-related diseases; cancer, diabetes, atherosclerosis and heart failure have all been associated with shorter telomere length; as are also obesity and smoking. The question is, do short telomeres cause all this bad stuff; or, does all this bad stuff cause shorter telomeres?

In these studies of associations, and the telomere test itself, it is the White Blood Cell (WBC) whose telomere is being measured. All of our other cells (brain, heart, etc.) have telomeres too, which are widely variable at birth and across population groups; but, they are much harder to sample for obvious reasons, as opposed to a finger stick for a tiny drop of blood. Perhaps the WBC telomeres are more a marker of inflammation, which is the root cause of the metabolic syndrome, diabetes, heart disease, and many types of cancer. Perhaps the telomere test is more a marker of lifestyle choices, the results of which should be no surprise, than it is of longevity.

I don’t think the telomere test is ready for prime time. There are too many variables and too many assumptions; and more importantly, what will it tell you that you don’t already know: that you should stop smoking, lose weight, and control your blood sugars if diabetic? Well, let me say it then. Stop smoking, lose weight, and control your blood sugar. That will be $300 please, and you didn’t even have to give me a blood sample.

Additional Online Only Edition:

The nucleotides in DNA are; Adenine, Cytosine, Guanine, and Thymine; A, C, G, and T; and in humans, the telomere is made of repeating sequences of TTAGGG repeats for a total telomere length of 8-15 kilobase (kb) pairs, or 8-15,000 base pairs. This sequence is shared with mice, rats, and birds; and slime mold has an extra “T” (TTTAGGG). Hmmm…I wonder if there’s slime mold in primordial soup.

The cells in our bodies are called somatic cells; they have differentiated from stem cells into specific cell types; and as such, suffer from mortality, being good for about 50-70 divisions before cell senescence or apoptosis, which basically means cell death or disintegration. In contrast, embryonic stem cells are as immortal as a cell can be in that it has high levels of a protein complex, called telomerase, which can rebuild telomeres; so, in the stem cell, the telomeres don’t wear out. Some cancer cells also have high levels of telomerase, which is a factor in a tumors relentless growth.

Most of the studies drawing age-related associations have been with the telomere length of WBCs, which may be a more accurate measurement of the inflammatory state. The telomere lengths of various organs are widely variable from person to person, and from organ to organ within an individual. Do those individuals with shorter telomeres at birth of the heart cells have a shorter life span than those of an individual with longer ones? Do people that die at a young age from illness have shorter telomeres than age-matched controls?

I think the telomere is a factor in aging, and potentially, eventually, subject to interpretation and intervention for longevity; but at this time the test result is, I think, nothing more than a curious novelty, no more accurate than having your palm read at a carnival.

 

 

2010 Dietary Guidlines

I’ve spent about 3-4 hours going through the 2010 dietary guidelines, and didn’t learn anything new. Of course, I probably already know more than the average reader, given my research for “The Relativity Diet;” still, I was hoping for more. There has been much debate, and research these past five years (since the last round of recommendations in 2005). All of the pertinent links can be accessed here.

The guidelines are based on nearly two hundred questions from eight broad topics: Alcohol, Carbohydrates, Energy Balance and Weight Management, Fatty Acids and Cholesterol, Food Safety and Technology, Nutrient Adequacy, Protein, and Sodium, Potassium and Water.

I was most interested in the questions pertinent to low-carbohydrate diets.

Here are some of the conclusions, the validity of which I hold suspect:

“There is strong and consistent evidence that when calorie intake is controlled, macronutrient proportion of the diet is not related to losing weight.”

“A moderate body of evidence provides no data to suggest that any one macronutrient is more effective than any other for avoiding weight re-gain in weight reduced persons.”

“A moderate amount of evidence demonstrates that intake of dietary patterns with less than 45% calories from carbohydrate or more than 35% calories from protein are not more effective than other diets for weight loss or weight maintenance, are difficult to maintain over the long term, and may be less safe.”

In digging through the studies, and believe me, it was painful. I finally linked to the quoted studies, than accidently closed out the parent page and had no idea how I got there in the first place. One of the primary studies listed in support of the first conclusion listed above was of a cumbersome design that I described in my chapter on low-carbohydrate diets, with my impression being that it was almost designed to demonstrate the conclusions it drew.

The recommendations are not too dissimilar from 2005, and can be reviewed in the above link.

Eat less; low fat, whole grain, with half your plate holding fruits and vegetables, limit sodium intake to less than 2300mg/day, and so on. “Enjoy your food, but eat less,” and “avoid oversized portions.” Wow, that was almost worth the million dollars.

As I’ve said, there is plenty of debate regarding the macronutrient fractions of our diet, the exact role of high cholesterol (if any) in heart disease, and the sole emphasis on a caloric controlled, high-carbohydrate (65%) as the only way. I found the 2010 guidelines insipidly tedious, and as palatable as a bowl of cold Pablum. Instead of boldly going where no government agency has gone before, the Dietary Guidelines Advisory Committee has once again limped across their five-year finish line with a tired refrain based on political correctness and ideology.

A Higher Power

Simply posting my monthly contribution to the NWTC Newsletter, “What’s Cooking?”

There have been a couple of nutrition-related news stories that caught my attention this year past. Perhaps you’ve heard of them? The first one relates to the professor of nutrition at Kansas State University who lost 27 lbs. eating Hostess Twinkies, but to add variety, he also consumed Doritos, sugary cereals and Oreos. Ouch! Let me have some of that pain. Now, the last Hostess Twinkie “fan” of my acquaintance was a morbidly obese, Army-reservist drill sergeant with a malignant personality who tortured me one long summer, long ago in Ft. Leonard Wood, MO–but I digress. The difference between Sgt. Jefferson and the good professor is that the professor limited his caloric intake of all these things sweet to 1800 calories a day. The professor’s daily caloric need for maintenance was 2600 calories. Well? What do you think happened? Naturally, he lost weight. And in losing weight by eating a restricted diet of treats, he made international news. Big deal. This is nothing more than a validation of the first law of thermodynamics (energy cannot be created or destroyed); and should come as no surprise to anyone. I wrote about the exact same concept in The Relativity Diet three years ago, only proposed it as a snicker-bar diet. Unfortunately, I didn’t actually go on the diet—it seems that I probably should have.

The second story is a bit more subtle, slightly more nuanced, tinged with enough science and techno-wizardry to tease one with the promise of possibility. This story too was on all the major networks. It is a story of a gene test—send in a swab of spit, and for around $150 dollars you will find out which type of diet program will work the best for you: the choices being a low-carb, low-fat, or balanced diet, in addition to a targeted exercise program. The claim is based on a study from Stanford in 2007, which I actually summarize on page 282 of my book. Briefly: the study divided 311 women into four groups/diets; Atkins, Zone, low-fat/high-carb (LEARN), and Ornish (vegetarian, high-carb, less than 10%fat). The company selling the test sent swabs to all of the participants of the study, about 30% returned their saliva, and the retrospective (not ideal) results suggested that the women whose genes were matched to their diet lost five times more weight than if they were mismatched. The premise being that a woman whose genes are better for a carb-reducer diet will have difficulty on a low-fat/higher-carb diet. The findings suggest that 45% do best with carb-reducing diets, 39% with lower fat diets, and 16% with balanced diets.

So, do the results warrant one Ben Franklin and half of another? I don’t think so; not yet anyway. Genetics certainly does play a role in obesity, which would require a book or at least a chapter to expound upon; but, the answer is not the test. It is more simple than that.

We know from the above, that, no matter what, ultimately, it’s the calories that matter. You have to account for energy consumed, whether it be Twinkies or beef steak. The next most important things are having an awareness of the role of carbohydrates, taking control of your insulin/glucose axis with a reasonable limitation of the quantity of (good) carbohydrates; and focusing on controlling your intake of (good) fat. The last thing is dialing in a balance of aerobic and resistance exercise. I’m generally not one to say “I told you so.” But, in fact, I did (on page 343) Count calories, eat lower-fat foods and low-glycemic carbohydrates, and look for foods that have almost as much protein as carbohydrates.

I find it irritating, these claims of the discovery of something novel, new, magical, that will somehow make weight-loss easier, less painful, as though you might operate outside of the laws of logic. It is not a matter, at this point in time, of a pill, a test, or a bar. It is a matter of knowledge, empowerment, and the exercise of a free will; perhaps, even, in the belief of a power higher than yourself.

Weight Maintenance II

Consider someone fifty pounds overweight. Using the quick and dirty formula for caloric need (11 calories/pound), that amounts to 550 calories per day to maintain that excess fifty pounds. Now, considering nothing else than the first laws of thermodynamics (calories in=calories out), that someone will have to go on a “diet” that is 550 calories less than what they are currently consuming.

At the end of the “diet,” what would be the most logical maintenance mechanism? Continuing on the diet, of course, forever. If you go back to doing what you were before, there is only one outcome–regaining the weight commensurate with your caloric consumption and daily activity.

A problem arises when the “diet” is not valid long-term, which I allude to in the previous post. If you don’t have ownership of your diet, if it is foreign and not your own, then the risk of recidivism is much higher. This is why I think that you need to have a direct knowledge of the caloric content, carbohydrate and protein content of the foods you eat as opposed to a “system” that gets between you and your energy consumption.

Don’t forget that there are many variables; Diet Induced Thermogenesis, daily exercise (aerobic and resistance training) to elevate your BMI, the timing of meals, and other strategies addressed in the book, all of which will facilitate both weight-loss and maintenance; because, for all my grousing about calories in and calories out, it is obviously more complex than that.

A strategy, implied in the above, that would be helpful for maintenance would be the addition of lean muscle tissue (weight-lifting) to a significant extent, which will increase your basal metabolic rate. I exercise five to six hours a week, about half resistance based, and I’ve found that I maintain my goal weight within a fairly tight range, without having to specifically count calories.

After your “diet,” and by that I also mean your daily energy expenditure habits, becomes ingrained (your new normal), you will be able to do the same.

Your diet is temporary only in the sense that it lasts as long as it takes for you to follow it naturally, without having to count and keep track on a daily basis; and if you vary by more than 5% (like the Holidays), then you start keeping track again.