Reader’s Edition: How to Treat Obesity

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Thank you again for your responses to my question about obesity—you all did a great job. Some answers were short, and some went into a lot of detail. Just like last week, I’ve excerpted some of your answers. Enjoy reading what others have done and are doing, because if you have weight you’d like to abandon, you’ll find some tips in here to help you out.

A New Lifestyle
“It’s a lifestyle decision to make. Eat less by using a salad plate rather than a dinner plate—no seconds. Eat heart-healthy foods . . .

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Reader’s Edition: How to Prevent Obesity

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I want to thank all of you who responded—and there were plenty of you who took your time to do it! Some responses were just a single word such as “moderation” while others sounded familiar. “Eat less and move more” was the most common response; where have you heard that before?

Many of you took a lot of time and put thought into your answers, and I appreciate each and every one. Most answered the question of how to treat obesity once someone was obese. I’m going to use those a week from today because there were excellent . . .

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You’re the Expert

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After last week’s messages on sarcopenic obesity, a question came to mind: how would you prevent obesity? I’d like you to send me your answer by Friday at noon.

First, some rules. No theories you’ve read about in books, heard on the Internet, or any other expert’s opinion, including me for you long-time readers. What would you do and how would you do it given what you know?

Second, there are no good foods or bad foods. I don’t care about refined, organic, sugar, artificial this or that. You can use anything you find . . .

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Sarcopenic Obesity

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There is a lot that happens as we age. Especially in today’s society in the U.S. and Canada, one of the things that happens is we lose muscle mass. Why? We don’t use it. We tend to slow down as we age and don’t stress the muscles as much as we did when we were younger, and we usually don’t have as much to do—no job, no kids to run after, and so on. As a result, we lose muscle mass. That’s the sarco part of sarcopenic in the title of today’s . . .

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Pinch an Inch

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Have you ever hugged someone who looks to be normal weight but seems soft? You can tell that there isn’t much muscle under their clothes. These are the people who make up that additional 5% in the obesity statistics. They fall through the cracks in the BMI scale because their BMI is normal. There’s one more thing—in general, they’re 50 years and older. The largest group in that class is the baby boomers.

How can you have a normal BMI and be obese? The CT scan slices of human thighs give you an idea (no, those . . .

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Are We Fatter Than We Think?

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The number of people in the U.S. who are overweight and obese are about 70% according to the numbers reported by the Center for Disease Control. I hate to be the one to tell you, but that’s probably an underestimate. It’s probably closer to 75%. I can’t be more precise because of the way obesity is measured in large studies.

The Body Mass Index (BMI) is used to measure large groups of people. All you need is two measures: height and weight. Those are the basis for the statistics on overweight and obesity. From now on . . .

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Fruits, Vegetables, Weight Loss, and Independence Day

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This is a very long holiday weekend so I decided on a very long title for this week’s only message—three topics in one message. Let’s get to it.

Research Review: Fruits, Vegetables, and Weight Loss

The headlines have read “Eating Your Veggies Worthless for Weight Loss” and “Fruits and Veggies Won’t Lead to Weight Loss” this past week. They’ll certainly get your attention, but what’s it all about? Nothing. Really—nothing. Here’s why.

Researchers culled all the published studies looking for studies where subjects were told to add fruits and vegetables to their diet (1). The studies they included could not include any diets or attempts to lose weight—only additional vegetables and fruits. What they found is exactly what was reported: simply adding vegetables and fruit to your diet won’t cause you to lose weight.

Really? You mean an apple a day added to my highly-refined, deep-fat fried, and vegetable-free diet won’t help me lose weight? Not even adding a salad with half a bottle of blue cheese dressing?

I don’t know what they’re putting in the water at the University of Birmingham in Alabama research labs, but someone should check on it. This is the second study in two weeks that attempts to question what they believe is conventional thinking regarding weight loss. The other is that eating breakfast is worthless (2). In both cases, neither the headlines nor the researchers’ press comments represent in any way what the research actually examined.

Let me be clear, because they’re not: if you intentionally replace some of the highly-refined and high-fat foods with fruits and vegetables, you will lose weight. Period. And you can start this 4th of July by eating red, white, and blue.

Fruits, Vegetables, and the 4th of July

Red. White. Blue. As you celebrate this week with the rest of America, make sure that whatever you eat this week, it contains some foods with the colors of our flag, and challenge your kids to do the same. Those colors of the flag represent our independence. You can start your journey to physical independence from disease by starting this week to get at least seven servings of vegetables and fruit in your everyday diet.

Do desserts count? Sure, why not, as long as there’s at least a half cup of fruit in your serving.

Here are some examples:

Red: tomatoes, ketchup, strawberries, watermelon, raspberries, cherries and every variety of red-skin apples. Even barbecue rubs that contain paprika, chili powder, and other red spices have great nutrients that are good for us.

White: onions, garlic, potatoes, turnips, parsnips, and every type of apples. Yes, because of the excellent nutrients and fiber in apples, they can fall into two categories.

Blue: blueberries, blackberries, blue cheese dressing—because if you’re smoking wings, you have to dip them in something! Remember, it’s always about the quantity.

That’s a good beginning that you can carry over into your everyday life. Add the green and yellow and you’re on your way! Set your path for health independence by eating your vegetables and fruit this 4th of July and every day from now on.

Happy Independence Day

Paula and I wish you the best this 4th of July and every day. If you’re driving, be safe in your travels.

What are you prepared to do today?

Dr. Chet

 

Forks Over Knives

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I like writing the Saturday messages because it allows me to review scientific articles or controversies in health in a little more depth. Today I’m going to give you my thoughts on the movie Forks Over Knives, written and directed by Lee Fulker. The movie was exactly what I thought it would be, and at the same time completely different from what I expected. Let me give you a summary of the movie, what I thought was good, and what I found lacking.

Summary

Forks Over Knives chronicles the careers of two scientists, T. Colin Campbell and Campbell Esselstyn, and how they arrived at the same conclusion: plant-based diets will eliminate or dramatically reduce the degenerative diseases we face today such as heart disease, diabetes, and cancer. There are a couple of other well-known plant-based diet activists including Dr. John McDougall and Dr. Neal Barnard from the Physicians Committee for Responsible Medicine (PCRM).

The movie also tracked several people, including the writer, who changed to a plant-based diet and experienced a reduction or elimination of medications, weight loss, and dramatic improvements in measures of health such as blood pressure and blood cholesterol.

As you watch the movie, you’re drawn into the purported benefits of the plant-based diet—everyone would want the results the people in the movie got. The science presented seemed to be clear, from the rodent studies that Campbell used to determine that protein causes cancer to the ongoing study by Esselstyn tracking the cardiovascular health of people given up for dead by their cardiologists. Switch to a plant-based diet and you can give up all medications, improve your sex life, lose weight, improve your fertility, and live longer. Who could argue with that?

What I Liked

In the opening paragraph, I said that the movie was different from what I thought it would be so let me cover that first. I thought this would be the typical “show the slaughterhouse to gross people out” approach, but they didn’t do that at all. That’s a plus, because we get enough violence in other movies.

I thought they did a good job of explaining endothelial cells and why they’re integral to the health of your cardiovascular system (I’m covering that in an upcoming American Heart Month message, so if you don’t know about them, you will.) Ditto for C-reactive protein, the blood measure of inflammation in the body. They also mentioned, but didn’t explain in detail, the role of nitric oxide in the body. I think that’s central to the concept of why a plant-based diet is essential for health.

What I Found Lacking

Most of the problem I had was with T. Colin Campbell’s research, including rodent studies and what he’s most famous for, the China Study.

In his rodent research, he spent years studying the effects of protein on the development of cancer, according to the movie. Basically, he suggested that when you expose rats to animal protein at 20% of caloric intake, they develop cancer. If you lower it to 5%, they stop growing cancer. In one study, he claims they could turn off the growth of cancer like a light switch by switching from 20% to 5%, and then turn it back on by jumping up to 20% again.

What he didn’t say was important. The rats did not spontaneously develop cancer as suggested; only those exposed to high levels of a nasty carcinogen called aflotoxin developed liver cancer with the high-protein diet. And it wasn’t a common protein; it was casein, one of the two proteins found in milk. To make the leap from a protein no one (or no animal) would ever find in nature to suggesting that all protein causes cancer is a stretch—actually it’s like jumping the Grand Canyon. To make this research meaningful, a follow-up study needs to be done using a variety of protein; if that yields the same results, then it’s time to see if the same process applies to humans. But to not give all the details of that research while making such sweeping claims was inappropriate.

Let’s turn to the China Study, one of the largest studies of its kind. Campbell and a Chinese counterpart headed a study to find out the causes of cancer in China. The simple answer was that as dietary protein levels increased, so did all types of cancer; rural areas had the lowest protein intake and the lowest rates of most cancers, while urban areas had a much higher protein intake and thus more cancers. Seems simple, doesn’t it?

Not so fast. There are at least three very important variables that we know affect cancer rates that they didn’t address in the research or the movie:

  • What was the difference in physical activity levels in the rural versus urban areas? The majority of the people in rural areas were farmers who were physically active all day long. We know activity affects disease, so to leave that out of the equation makes the results suspect.
  • The volume of food was different between the rural and urban areas: those in rural areas chronically under eat. Intermittent famine has benefits even if it’s just one day a month. Total caloric intake could more than explain the difference in cancer rates.
  • The people in rural areas weighed less than their urban counterparts. Excess body fat is a risk factor for several types of cancer, including breast and prostate cancer.

As for Dr. Esselstyn, while he has demonstrated that his approach to a plant-based diet will literally bring people back from heart death, there were other factors that have to be considered: he talked with his patients every two weeks; they had cooking sessions in patients’ homes; they had group meetings on a regular basis; his wife taught them how to cook vegetarian meals.

Here’s my question: how do we know that it wasn’t the additional attention that was important to those patients and made the difference in their health? The relationship between mental state and health may be fuzzy, but it exists; people with untreated depression are sick more. I’m not suggesting the diet wasn’t important, but the personal attention had to account for part of the program’s success. Would you get that level of attention from your doctor? If not, you might not get the same results.

The Bottom Line

There’s a scene in the movie that really captures the essence of what I believe: Campbell implies that the members of some of the committees of the USDA are too closely tied to agri-business, and that influences the recommendations the committee makes. Dr. David Klurfeld heads the Committee on Human Nutrition of the USDA. In response to the accusation that committee members have a conflict of interest, he said that there’s also an inherent conflict of interest by Campbell, Esselstyn, and others who promote a plant-based diet: they have chosen a position and defend it with only the data that supports their position. I couldn’t agree more. The problem with the movie is it provides only one view of a very complex subject while omitting important facts and variables.

Having said that, I think you should rent or buy the movie and watch it, because I think moving to a diet that is 80% to 90% plant based is really important for our health. When combined with reducing the refined foods in our diet and eating quality protein, that’s the nutritional approach that will benefit your heart and cardiovascular system.

What are you prepared to do today?

        Dr. Chet