Even if heart disease “doesn't run in your family,” this article is for you. Even if you have low cholesterol levels and your blood pressure is normal, this article is for you, too. This information doubles as both prevention and treatment— and its knowledge is critical for us all.

In the past, you may have thought of heart disease as an illness that you associated predominately with men. These days, we know that more than one in three women have some form of cardiovascular disease. As of the 2016 fact sheet from the American Heart Association, 398,086 females passed away from cardiovascular disease or congenital cardiovascular disease, with 402,851 males passing away from the same. Further, they've found that 90 percent of women have one or more risk factors for heart disease or stoke and that fewer women survive their first heart attack than men. This illness clearly does not favor one gender.

So, what causes heart disease? Simply put, cardiovascular disease results when the lumens of the coronary arteries, which carry blood, oxygen, and nutrients to the heart, become smaller. This constriction can be caused by excess salt in the blood pulling fluid from the arteries. Arteries are further constricted by a buildup of fats, oxidized cholesterol, excess calcium, and plaque in the artery walls. Angina, or chest pain, occurs when the heart fails to receive enough oxygen through these narrowed arteries. When these arteries become obstructed, a heart attack can occur, resulting in damage to the heart tissue. This process of plaque buildup and obstruction is known as atherosclerosis, or hardening of the arteries.

What Are the Risks?
There are over 250 risk factors for heart disease that have been identified. However, you'll be relieved to know that a large number of these factors—including many that are especially dangerous—can be lowered with lifestyle choices and changes. However, two risk factors associated with heart disease are beyond your control: heredity and age. For both men and women, the closer your blood-tie to a relative who suffered from heart disease, the greater your risk of developing it. In addition, age is a factor for women. As women reach menopause, their risk factor of developing heart disease rises significantly. Regardless if your family history predisposes you to a higher risk or not or your current age, there are certain risk factors that you should be mindful to pay close attention to. Let's touch on a few that you can begin making changes to reduce today.

High Blood Pressure
Hypertension, or high blood pressure, is both a cause and an effect of cardiovascular disease. The exact cause of hypertension is generally unknown, but what we do know is that high blood pressure often accompanies heart disease. The excessive force of the blood against the arteries weakens the cellular walls, allowing LDL (“bad”) cholesterol, excess calcium, and other toxic substances to form deposits that eventually block the arteries. Almost 50 percent of all midlife women are diagnosed with hypertension by age 50. Most who have hypertension are unaware of it because it usually produces no physical symptoms. Routine blood pressure checks, at least every two years, can detect potential hypertension; blood pressure readings above 140/90 may spell danger. Because so many test results have shown a direct relationship between high salt intake and hypertension, removing the salt shaker from your table would be wise. Sodium is a factor in hypertension because it causes fluid retention, which adds stress to both the heart and the circulatory system. Hypertension, left undiagnosed or untreated, can result in stroke, heart attack, kidney failure, and other serious diseases.

Smoking
Let's face facts: if you still smoke, your chances of dying from heart disease are almost three times as great as those of dying from lung cancer. The negative effects of smoking on your cardiovascular system are related to several actions. Nicotine causes blood platelets to become sticky, increasing plaque formation. Smoking also has been shown to decrease levels of HDL (“good”) cholesterol and increase LDL (“bad”) cholesterol. Cigarettes are high in cadmium, a toxic mineral that damages heart tissue. The Nurses' Health Study, conducted by Harvard researchers, found that women who smoked just one to four cigarettes a day had nearly two and one-half times the rate of heart disease of nonsmokers. Keep in mind that even secondhand smoke increases your risk of heart disease, so make your home and car smoke-free environments.

Obesity
Unfortunately for us, weight appears to be a more significant risk factor for women than it is for men. A study by Harvard researcher JoAnn Manson, MD, found that in obese women, seven out of ten cases of heart disease resulted from their excess weight. Even women who are at the high end of their “normal” range seem to have an increased risk. To compound the problem, overweight women tend to be sedentary; they are also more likely to develop hypertension, high LDL cholesterol and triglycerides, and type 2 diabetes, all of which increase the likelihood of heart disease. How the weight is distributed on your body also seems to have an impact.

Women with an apple body shape—who have a proportionally higher amount of fat around their abdomen than elsewhere on their body—have higher rates of heart disease, hypertension, and diabetes than their pear-shaped sisters, who carry their excess fat in their hips and thighs. Scientists believe this association relates to the hormone cortisol, which causes fatty acids to be released into the bloodstream from the central fat cells. These cells are located close to your liver; the released fatty acids stress the liver, causing cholesterol, blood pressure, and insulin levels to rise. Psychology researcher Elissa S. Epel has also discovered that apple-shaped women feel stress more and produce more cortisol as a result than do pear-shaped women.

Diabetes
For us women, diabetes is an additional risk factor for heart disease. Blood platelets in diabetics seem to stick together more readily than in non-diabetics, causing clogging of the arteries. Diabetics also have higher total cholesterol and lower HDL cholesterol levels. Research shows that women over the age of 45 are twice as likely as men to develop type 2 (formerly known as adult-onset) diabetes, and female diabetics are at double the risk of heart disease of male diabetics. The good news is that type 2 diabetes can be managed with diet and exercise.

A Sedentary Lifestyle
Movies depicting life on the nineteenth-century American frontier and Canadian wilderness are harsh reminders of just how physically demanding everyday life once was. We might enjoy watching someone else chop wood, carry buckets of water long distances, and walk behind a plow horse, but few of us would trade in our computers, microwave ovens, and central heating to live that life. All our muscles, including our heart, need exercise, however. Exercise helps lower LDL cholesterol and raise HDL cholesterol. Regular aerobic exercise—such as walking, running, jumping rope, and dancing—reduces the risk of heart disease by about 30 percent in postmenopausal women. It also influences several other risk factors.

People who exercise regularly have a 35 percent lower risk of hypertension, as well as a lower risk of diabetes. Exercise stimulates production of serotonin, endorphins, and other brain chemicals that reduce anxiety and stress and create a balanced sleep-wake cycle, helping to control cortisol levels. When you exercise, you also aid calcium metabolism, triggering the calcification process within your bones so excess calcium does not build up in your blood vessels. And you don't even need to spend one to two hours a day in strenuous activity to achieve cardiovascular benefits. Do keep in mind that over exercising can be just as harmful as being a couch potato. Moderate exercise, performed regularly, significantly decreases your risk of heart disease.

No matter your age, stage, and gender, it's import to make daily choices that love your heart and your health.

Overweight, often diagnosed as obesity, has become a major health issue in the United States as well as other countries. During the last four decades the prevalence of obesity has been growing at alarming rates, increasing risk factors that constitute the cluster of metabolic syndrome (MS), a condition characterized by, and rise in the risk of a variety of ailments, notably heart disease, stroke, inflammation, diabetes and certain cancers.

Hallmarks of the metabolic syndrome include abdominal obesity, increased blood pressure, (hypertension), elevated triglycerides and LDL cholesterol, that are harmful lipids, a reduction in plasma high density lipids, HDL cholesterol (the good cholesterol), and insulin resistance, a condition in which the body cannot use its insulin to move sugar into cells for energy, resulting in high blood sugar and diabetes. Studies now show that metabolic syndrome or its components, such as overweight, are associated with increased risk of cardiovascular disease as well as the development and progression of cancers of the breast, endometrium, colorectal, pancreas, liver and kidney.

Overweight And Health Problems
Both clinical and experimental studies have established that overweight increases the risk of a variety of detrimental health conditions, including oxidative stress, high blood pressure, high LDL and triglycerides, promoting atherosclerosis, coronary heart disease and stroke. Overweight can harm other aspects of health. It is a major cause of gallstones, can worsen degenerative joint diseases, play a role in cancer and sleep apnea. Lowering weight to a healthy level reduces these risk factors and causes blood to circulate more effectively. Overweight and frank obesity can lead to low-grade inflammation that is associated with the fat tissue that produces and secretes a variety of inflammatory molecules, increasing the risk of CVD and other pathological conditions.

Adiponectin
Adiponectin is the most abundant protein secreted by fat tissue into the bloodstream. It is considered a protective protein and has anti inflammatory, anti atherogenic as well as insulin sensitizing properties. Ironically, and contrary to expectations, despite being produced in fat tissue, adiponectin is decreased in obesity and its levels are inversely correlated with the percent of body fat; that is, the fatter the person the lower adiponectin levels. Adiponectin has regulatory functions that help combat risk factors associated with metabolic syndrome, including regulation of metabolic changes that occur in persons with conditions of type 2 diabetes, obesity, and atherosclerosis; adiponectin protective effects include increased insulin sensitivity and a lowering of the risk of cardiovascular disease. In cases of overweight and obesity, where adiponectin is low, an enhancement of adiponectin levels would be of therapeutic value.

The search to reduce the risk of the adverse effects of metabolic syndrome and overweight discovered garlic (Allium sativum L.). Garlic has been used as a nutrient with beneficial cardiovascular effects. However, fresh garlic is not for everyone, as its beneficial effects are offset by its pungent odor that lingers on breath and skin and its ability to often cause indigestion. An alternative source of garlic that is odorless and rich in antioxidants is the natural supplement Kyolic Aged Garlic Extract (AGE), having a wide range of health effects, that are often more effective than the fresh bulb.

Kyolic Aged Garlic Extract^TM (AGE)
Kyolic Aged Garlic Extract (AGE), is an odorless natural garlic supplement, manufactured by Wakunaga of America, from organically grown garlic that has been extracted and aged for 20 months, at room temperature. Rich in water-soluble organosulfur compounds, such as S-allyl cysteine and S mercaprocysteine, that has antioxidant activity; AGE is found, in experimental and clinical studies, to help prevent a wide range of ailments, notably coronary plaque formation and atherosclerosis, thereby reducing the risk of heart disease and stroke. Other health benefits include anti-inflammatory effects, boosting immunity, lowering blood pressure, reducing the risk of certain cancers, notably colorectal cancer, and preventing the toxic effects of radiation and certain drugs, such as acetaminophen, that when taken in high doses can cause liver failure. AGE is highly bioavailability and its wide range of health effects have been proven in clinical and experimental studies, reported in over 700 peer reviewed scientific and medical publications.

AGE And Adiponectin
A clinical trial, by D. Gomez-Arbelaez and colleagues, set out to investigate the effects of AGE on adiponectin and metabolic risk factors that constitute the metabolic syndrome. The clinical trial was a double blind, placebo controlled, randomized, crossover study, carried out on a Colombian urban population with metabolic syndrome.

The Study
The study selected 46 men and women over 18 years old with a metabolic syndrome diagnosis, a diagnosis based on obesity (waist circumference larger than 90 cm for males and greater than 80 cm for females).

Other hallmark characteristics included: triglycerides above 150 mg/dL, HDL lower than 40 mg/dL (male) and 50 mg/dL (female), blood pressure higher or equal to 130/85 mmHg, and fasting plasma glucose levels higher than 100 mg/dL. The investigators divided the subjects into two groups of 23, with each group being randomly assigned to ingest either 1.2 g/day of AGE (Kyolic) or placebo; Following 12 weeks of supplementation, treatment was reversed for another 12 weeks; that is, the ones who received AGE now received a placebo and those who were on placebo received AGE. The subjects received AGE or placebo as identical capsules, taken twice day, with breakfast and dinner. All subjects received recommendations for a lifestyle that included a diet lower in fat and sugar and exercise, and an exercise regimen of 30-minutes/day moderate walking. The subjects were followed every four weeks to evaluate clinical endpoints. At the beginning and end of each phase of the study (week 12 and week 24), investigators assessed weight, height, body mass index (BMI), that measures body fat, depending on height and weight, waist and hip circumferences and blood pressure.

The Findings
Results from the study showed that AGE intake for 12 weeks increases adiponectin levels. The increase in adiponectin, following AGE, was statistically significant, an important finding, since decreased adiponectin levels (4 µg/mL) are associated with doubling the frequency of coronary heart disease, independent of other cardiovascular risk factors, as well as insulin resistance, diabetes type 2, atherosclerosis and hypertension.

This first demonstration of AGE enhancement of adiponectin has a wide range of potential results; adiponectin increases cellular glucose uptake by cells and prevents excess blood glucose levels; adiponectin inhibits inflammation and oxidative stress, protecting blood vessels against oxidative damage that can cause cell death. AGE-induced increase in adiponectin would result in AGE influencing the improvement of insulin resistance and increasing sensitivity, thus playing an important role in helping prevent diabetes.

Another mechanism which can be linked to AGE increasing adiponectin levels and AGE protection against cardiovascular disease, is the regulatory mechanism associated with nitric oxide (NO). Nitric oxide is a regulator of blood pressure and is important in cardiovascular protection. AGE enhances NO production, and NO regulates adiponectin levels, which, as shown above is critical in modulating risk factors in metabolic syndrome.

AGE Improves Metabolic Parameters In Obese Models
While AGE, by enhancing the levels of adiponectin helps protect obese individuals against heart disease and other pathological aspects of metabolic syndrome, an experimental study from Korea, by Seo and colleagues studied the effects of AGE in experimental models fed a high fat diet, and made to exercise. AGE proved to have an additive anti-obesity and cardio-protective effect, reducing body fat, lowering cholesterol and triglycerides and reducing inflammation.

The Bottom Line
The study by Arbelaez adds to the wide range of important AGE health effects. The clinical study shows for the first time that AGE, added to the diet of overweight men and women with metabolic syndrome (MS), for 12 weeks, increases adiponectin, lowering their risk against heart disease, stroke, insulin resistance, diabetes type 2 and other conditions associated with metabolic syndrome. In addition, the study by Seo et al shows that AGE has anti-obesity properties.

Putting the two studies together, AGE can reduce body fat and potentially prevent the onset of MS; moreover, in the situation where a person is already overweight or frankly obese and diagnosed with metabolic syndrome, AGE added to the diet can, within a short period of 12 weeks, help protect against the symptoms of MS by increasing adiponectin production.

References:

Diego Gomez Arbelaez, Vicente Lahera, Pilar Oubina et al Aged Garlic Extract Improves Adiponectin Levels in Subjects with Metabolic Syndrome: A Double Blind, Placebo Controlled, Randomized, Crossover StudyMediators Inflamm. 2013;2013:285795. doi: 10.1155/2013/285795. Epub 2013 Feb 28.

Weiss N, Papatheodorou L, Morihara N, Hilge R, Ide N. Aged garlic extract restores nitric oxide bioavailability in cultured human endothelial cells even under conditions of homocysteine elevation. J Ethnopharmacol. 2013;145:162 7.

Seo DY, Lee S, Figueroa A, Kwak YS, et al. Aged garlic extract enhances exercise mediated improvement of metabolic parameters in high fat diet induced obese rats. Nutr Res Pract. 2012: 6; 513 9. doi: 10.4162/nrp.2012.6.6.513. Epub 2012 Dec 31.

Ahmadi N, Nabavi V, Hajsadeghi F, et al. Aged garlic extract with supplement is associated with increase in brown adipose,decrease in white adipose tissue and predict lack of progression in coronary atherosclerosis Int J Cardiol. 2013;168:2310-4. doi: 10.1016/j.ijcard.2013.01.182. Epub 2013 Mar 1.

In aging and many disease states, the energy production capacity of the body’s cells is diminished. The mitochondria are the structures within the cell responsible for generating energy from oxygen and nutrients. If their number is reduced or their function is impaired, free radicals are produced and damaging toxins accumulate in the cells. These toxins further damage the mitochondria and impair other aspects of cellular function. Many of the most common health problems, such as obesity, diabetes, and many problems associated with aging, arise from problems in cellular energy production. As one group of researchers has put this, "[a]ging is associated with an overall loss of function at the level of the whole organism that has origins in cellular deterioration. Most cellular components, including mitochondria, require continuous recycling and regeneration throughout the lifespan."¹ Another has observed, "[m]itochondrial biogenesis [the creation of new mitochondria] is a key physiological process that is required for normal growth and development and for maintenance of ongoing cellular energy requirements during aging."² These observations link two key aspects of mitochondrial health, preventing and removing damaged mitochondria (mitophagy) and creating new mitochondria (mitogenesis).

Although the importance of the mitochondria as a central point of health has been accepted for decades, over the last few years the understanding of the mechanisms involved has changed significantly. Twenty or ten years ago, antioxidants and the free radical theory of aging largely dominated thinking. Today, the importance of mitochondrial biology linking basic aspects of aging and the pathogenesis of age-related diseases remains strong, yet the emphasis has changed. The focus has moved to mitochondrial biogenesis and turnover, energy sensing, apoptosis, senescence, and calcium dynamics.³

What Promotes Mitochondrial Biogenesis?
The body maintains a complex network of sensors and signaling functions to maintain stability despite a constantly changing environment and numerous challenges. Of special note is the concept of hormesis, meaning a state in which mild stress leads to compensation that improves the ability of the body to respond in the future to similar challenges. It turns out that many of the approaches that are associated with longevity and healthy aging promote hormesis. In terms of mitochondria biogenesis, these include caloric restriction, certain nutrient restrictions or shortages, caloric restriction mimetics, and exercise.

Many of the mechanisms that activate mitochondrial biogenesis in the face of hormesis have been elucidated. Keeping in mind that there always must be a balance between the elimination of worn-out and defective mitochondria and the generation of new ones, the activators of both actions can overlap. For instance, low energy levels (caloric restriction) and increased reactive oxygen species/free radicals can promote the activity of special cellular control points. These include activating metabolic sensors such as AMP kinase/ AMPK (adenosine monophosphate kinase) and the protein known as SIRT1 (sirtuin 1, i.e., silent mating type information regulation 2 homolog 1). Activated AMPK is an indicator that cellular energy is low and serves as a trigger to increase energy production. It inhibits insulin/IGF-1/mTOR signaling, all of which are anabolic and can lead not just to tissue production, such as muscle growth, but also to fat storage. Along with SIRT1, AMPK activates the biogenesis of new mitochondria to enable the cell to generate more energy. At the same time, activated AMPK and SIRT1 increase the activity of a tumor suppressor that induces mitophagy. The balance of the dual activations replaces defective mitochondria with newly formed functionally competent mitochondria.

A key to health and healthy aging is to regulate the catabolic processes via controlled amounts and types of stressors such that worn out mitochondria are removed without overshooting the mark and reducing overall cellular and tissue functionality. The most successful way to maintain this balance is to follow the body’s own natural metabolic signals rather than to attempt to override the body’s checkpoints. AMPK and SIRT1 ultimately are energy/nutrient sensors or control points. Hence rather than attempting to manipulate these directly, it likely is safer and ultimately more effective to address the factors in the cell that these sensors sense. The recent attention in the issue of aging to the role of NAD+ (the oxidized form of nicotinamide adenine dinucleotide) is a good example of this principle. Directions coming from the nucleus of the cell that help to regulate the normal production of NAD+ and the ratio between distinct pools found in the cytoplasm and in the mitochondria decline with age. The changes in the NAD+ from the nucleus lead to a disruption on the mitochondrial side. In terms of energy production, it is a bit like losing a link or two in the timing chain on your car engine with a resultant reduction in engine efficiency. To date, attempts to increase NAD+ in cells via supplementation with precursors have not proven particularly successful. Major benefits have been demonstrated in animal models only in the already seriously metabolically impaired or the relatively old. Recent research on oral supplementation has led to at least one extremely difficult article which, at least in this author’s opinion, delivers more smoke than heat.4,5 There is, however, an argument to the effect that supplementing together both nicotinamide riboside (a NAD+ precursor) and a sirtuin activator, such as pterostilbene, may prove to be more successful.

It turns out that there are key points in normal cellular energy generation processes that strongly influence the NAD+ pools available for the cell to draw upon and the rate at which NAD+ can be replaced in these pools. Aging has been shown to promote the decline of nuclear and mitochondrial NAD+ levels and to increase the risk of cancer along with components of the metabolic syndrome. It is significant that the risks of these conditions can be reduced in tandem. Three places to start are 1) the pyruvate dehydrogenase complex, 2) the tricarboxylic acid cycle (TCA cycle) also known as the Krebs Cycle, and 3) the malate shuttle. A fourth junction is Complex I of the electron transport system, again, in the mitochondria.6 Manipulation of steps (1) and (2) already is being used in cancer treatment.7 Readily available dietary supplements can influence all four of these metabolic bottlenecks.

Supplements for Promoting Mitochondrial Biogenesis
Medicine has started to pay a great deal of attention to effecting mitochondrial biogenesis through not just drugs, but also dietary supplements. Those interested should go online and look up "Mitochondrial Biogenesis: Pharmacological Approaches" in Current Pharmaceutical Design, 2014, Vol. 20, No. 35. Quite a few options are mentioned, including well known compounds, such as R-lipoic acid (including with L-carnitine), quercetin and resveratrol, along with still obscure supplements, including various triterpenoids and the Indian herb Bacopa monnieri.

Pomegranate, French White Oak and Walnuts
The pomegranate, with its distinctive scarlet rind (pericarp) and vibrantly colored seed cases (arils), is one of the oldest cultivated fruits in the world. This exotic fruit features prominently in religious texts and mythological tales and has been revered through the ages for its medicinal properties. An image of a pomegranate even can be found on the shield of the British Royal College of Medicine. Numerous studies have demonstrated the benefits of the fruit for cardiovascular health with other benefits suggested in areas ranging from arthritis to stability of cell replication to bone health. Now a study in Nature Medicine (July 2016) has uncovered perhaps the most important benefit of all, the ability of pomegranate compounds (ellagitannins) transformed by gut bacteria to protect the mitochondria of the muscles and perhaps other tissues against the ravages of aging. The mitochondria are the energy generators of the cells and the weakening of this energy generating function in an increasing percentage of mitochondria as we age is a primary source of physical decline over the years. Urolithin A, a byproduct of gut bacterial action on pomegranate compounds, allows the body to recycle defective mitochondria and thereby slow or even reverse for a time some of the major aspects of aging. The lifespan in a nematode model of aging was increased by more than 45 percent. Older mice in a rodent model of aging exhibited 42 percent better exercise endurance. Younger mice also realized several significant benefits.⁸

Beginning almost three decades ago, there were numerous speculations in the research world regarding the so-called "French Paradox" in which the French consumed quite large amounts of saturated fat in the form of butter and cheese, yet consistently experienced much lower rates of cardiovascular disease than did Americans. Not only that, the French, especially in the southwest of the country, typically led longer lives even in the areas noted for consuming large amounts of goose fat and pate de foie gras, which is to say, not just the Mediterranean diet based on olive oil, etc. One hypothesis put forth very early on was that it was the French consumption of red wine that protected them. It was thought that red wine components, including anthocyanidins, proanthocyanidins and resveratrol, are the protective compounds. Not considered until recently is that French red wines traditionally have been aged in casks made from white oak (Quercus robur). White oak contains roburin A, a dimeric ellagitannin related chemically to punicalagin. Human data show relatively good absorption and conversion of roburins into substances including urolithin A and ellagic acid—as compared with ellagitannins in general, which evidence only poor absorption. Hence, the benefits of good red wine traditionally produced and good cognac (also aged in oak barrels) involve urolithin A. Notably, the benefits of roburins, most likely derived from the conversion to urolithin A, go beyond mitophagy to include ribosomes, referring to cell components that translate DNA instructions into specific cellular proteins.^9,10,11,12

Other sources of ellagitannins have been shown to lead to the production of urolithin A by bacteria in the human gut. Not surprisingly, sources of ellagitannins are foods long associated with good health longevity, including not just pomegranate and oak-aged red wine, but also walnuts (and a smattering of other nuts), strawberries, raspberries, blackberries, cloudberries and even black tea in small amounts.

Exercise and Pyrroloquinoline Quinone (PQQ)
Peroxisome proliferator-activated receptor gamma coactivator (PGC-1á) is the master regulator of mitochondrial biogenesis.¹³ Exercise is perhaps the most significant activator of PGC-1á that most individuals can access. Exercise, furthermore promotes mitochondrial biogenesis through a number of other pathways, especially endurance and interval training.¹⁴

There are non-exercise options. You can’t take PGC-1á orally because it is a large protein molecule which does not survive digestion. PQQ is a small molecule that is available when ingested and that increases circulating PGC-1á. PQQ supplementation leads to more mitochondria and more functional mitochondria.¹⁵

Fasting, Ketogenic Diets and Fasting-Mimicking Supplements As already discussed, fasting promotes mitochondrial biogenesis by AMPK activation.¹⁶ AMPK senses the energy status of the cell and responds both to acute shortages, such as that induced by exercise, and to chronic shortages, such as from fasting. Probably due to an overall reduction in metabolic rate, chronic caloric restriction (as opposed to intermittent fasting) contributes to the health of mitochondria rather than biogenesis.¹⁷ The robustness of AMPK response decreases with age.¹⁸

Ketogenic diets (very low carbohydrate diets) also promote increases in mitochondria.¹⁹ Few individuals are willing or able to follow ketogenic diets chronically just as few individuals are willing to undergo routine fasts. Fasting-mimicking supplements offer an alternative approach. The dietary supplement (-)–hydroxycitric acid (HCA) is the best researched of these compounds. (Keep in mind that there is a vast difference in the efficacy of commercially available forms.²⁰) Researchers have proposed that HCA used properly can activate mitochondrial uncoupling proteins and related effects.²¹

Furthermore, according to a study published in the journal Free Radical Research in 2014, HCA improves antioxidant status and mitochondrial function plus reduces inflammation in fat cells.²² Inflammation is linked to the metabolic syndrome at the cellular level by way of damage to the antioxidant enzyme system (e.g., superoxide dismutase, glutathione peroxidase, glutathione reductase) and mitochondria. This damage, in turn, propagates further production of pro-inflammatory mediators (e.g., TNF-á, MCP-1, IFN-ã, IL-10, IL-6, IL-1â). HCA protected fat cells from ER stress by improving the antioxidant status to reduce oxidative stress (i.e., reduce ROS) and improve the function of the mitochondria to short circuit an ER stress—inflammation loop in these cells. Reducing TNF-á is important in that doing so removes a major impediment to mitochondrial biogenesis.²³

Other Supplements to Promote Mitochondrial Biogenesis

Scholarly reviews looking at natural compounds such as those that are found in anti-aging diets suggest yet other supplements to promote mitobiogenesis. For instance, it turns out that hydroxytyrosol, the most potent and abundant antioxidant polyphenol in olives and virgin olive oil, is a potent activator of AMPK and an effective nutrient for stimulating mitochondrial biogenesis and function via what is known as the PGC-1á pathway.²⁴ Another herb with anti-aging effect, this time by activating the malate shuttle mechanism mentioned above, is rock lotus (Shi Lian Hua). This herb has been described in detail in this magazine in the article, "Uncovering the Longevity Secrets of the ROCK LOTUS."²⁵

Conclusion
It is possible to improve the functional capacity of the mitochondria through dietary practices, exercise and supplements. Indeed, a number of compounds have been identified by researchers as mitochondrial nutrients. These compounds work together to increase the efficiency of energy production, to reduce the generation of free radicals, and so forth and so on. Likewise, these nutrients have been shown to improve the age-associated decline of memory, improve mitochondrial structure and function, inhibit the ageassociated increase of oxidative damage, elevate the levels of antioxidants, and restore the activity of key enzymes. Perhaps best of all, the body can be encouraged both to remove damaged mitochondria (mitophagy) and to create new ones, which is to say, mitochondrial biogenesis.

References:

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20. Louter-van de Haar J, Wielinga PY, Scheurink AJ, Nieuwenhuizen AG. Comparison of the effects of three different (-)-hydroxycitric acid preparations on food intake in rats. Nutr Metab(Lond). 2005 Sep 13;2:23.
21. McCarty MF. High mitochondrial redox potential may promote induction and activation of UCP2 in hepatocytes during hepatothermic therapy. Med Hypotheses.2005;64(6):1216–9.
22. Nisha VM, Priyanka A, Anusree SS, Raghu KG. (-)–Hydroxycitric acid attenuates endoplasmic reticulum stress-mediated alterations in 3T3-L1 adipocytes by protecting mitochondria and downregulating inflammatory markers. Free Radic Res.2014 Nov;48(11):1386-96.
23. Valerio A, Cardile A, Cozzi V, Bracale R, Tedesco L, Pisconti A, Palomba L, Cantoni O, Clementi E, Moncada S, Carruba MO, Nisoli E. TNFalpha downregulates eNOS expression and mitochondrial biogenesis in fat and muscle of obese rodents. J Clin Invest. 2006 Oct;116(10):2791–8.
24. Liu J, Shen W, Zhao B, Wang Y, Wertz K, Weber P, Zhang P. Targeting mitochondrial biogenesis for preventing and treating insulin resistance in diabetes and obesity: Hope from natural mitochondrial nutrients. Adv Drug Deliv Rev. 2009 Nov 30;61(14):1343–52.
25. http://www.totalhealthmagazine.com/Anti-Aging/Uncovering-the-Longevity-Secrets-of-the-ROCK-LOTUS.html.

Most people are well aware of the ever-increasing number of adults and children alike who suffer from obesity these days. It would be the understatement of the century to say we have a problem on our hands. It is also well known that there exists a strong link between diabetes and heart disease when it comes to our expanding waistlines, but new research is showing that our risk for suffering from allergies may be greatly increased with the size of our fat cells.

In 2008, the Centers for Disease Control and Prevention (CDC) released a report showing that about 34.9 percent of the U.S. population today is obese, which accounts for a whopping medical treatment cost burden of about $147 billion.¹ Since that time, the obesity problem has continued to grow (no pun intended) right along with the costs.

So what do all of these stats have to do with us clawing at the television every time we see another antihistamine commercial playing? A lot! It turns out that right along with the growing trend in obesity, we have also seen a drastic rise in the prevalence of allergies—especially those related to common foods. According to Food Allergy Research and Education, over 15 million people now suffer with food allergies.² To put things in perspective, we need to first connect the dots and understand if and how obesity inhibits our allergic response and predisposes us to various allergies.

The Journal of Allergy and Clinical Immunology has explored this concern through a publication based on the National Health and Nutrition Examination Survey.³ A sample group of obese subjects between the ages two and nineteen were chosen for the study. The researchers sought to look at the association between obesity and immunoglobulin E (IgE) levels. IgE level indicates the allergic activity that takes place in the human body. Based on the IgE activity, the researchers concluded that obesity could have a direct relationship with allergic diseases in children, particularly when it comes to food.

Asthma and Obesity
According to the latest stats from the Asthma and Allergy Foundation of America, 44,000 people have asthma attacks, 36,000 children miss school, 27,000 people miss work, and nine people die due to asthma every day. It is also considered a contributing factor for over 7000 deaths each year. The most concerning fact here is there is evidence to suggest obesity plays a major role in asthma by weakening the body’s allergic responses.

A study published by Harvard School of Public Health indicated that adiponectin—a metabolic hormone produced by the fat cells, which has anti-inflammatory properties—could exert a positive reaction when it comes to allergic induced airway inflammation. Obese people tend to have lower levels of this anti-inflammatory hormone, which places them at a much higher risk for allergic asthmatic reactions.⁴ It is important to understand that when a person suffers an asthmatic attack, the difficulty in breathing is caused mainly because of excess inflammation in the airways. With the absence of adiponectin to alleviate this, the effect of the asthmatic attack goes somewhat unhindered in those who carry too much body fat on their frames.

Ineffective Meds
Even the medications such as inhaled steroids for asthma are less effective in overweight and obese children. A 4-year National Institute of Health (through its Childhood Asthma Management Program) study on overweight and obese children looked at hospitalizations and ER visits due to asthma. The study showed that inhaled steroids were less effective on the overweight and obese kids compared to children who were of normal weight.⁵ Asthma is the most common chronic condition in children today and is often triggered by allergies, which makes the ineffectiveness of medications due to obesity a concerning fact.⁶

The question that we must ask ourselves is, “Does weight reduction help in controlling asthma and allergic responses?” A study by the University of Newcastle says, “Yes.” ⁷ The study was conducted over a period of 10 week pilot study where the weight of asthmatic children was brought down through dietary intervention. The results concluded that diet-assisted weight loss could drastically affect the clinical outcome of asthmatic obese children. So, ultimately, the impetus is on adaption of a healthy diet and active lifestyle, which ultimately helps our children and us stay lean, and living a leaner life also helps us control the rate of allergic reactions. Talk about a WIN, WIN scenario!

References:

1. Centers for Disease Control and Prevention, Overweight and Obesity
2. Food Allergy Research and Education, Food Allergy Facts and Statistics for the U.S.
3. Visness CM, et al. Association of obesity with IgE levels and allergy symptoms in children and adolescents: Results from the National Health and Nutrition Examination Survey 2005–2006. Feb 23, 2009
4. Shore SA1, Terry RD, Flynt L, Xu A, Hug C. Adiponectin attenuates allergen-induced airway inflammation and hyperresponsiveness in mice. The Journal of Allergy and Clinical Immunology. 2006 Aug;118(2):389–95
5. National Academy on an Aging Society. Chronic conditions: a challenge for the 21st century. Num 1, Nov 1999
6. Forno E, Lescher R, Strunk R, Weiss S, Fuhlbrigge A, Celedón JC. Decreased response to inhaled steroids in overweight and obese asthmatic children. The Journal of Allergy and Clinical Immunology. Mar 2011; 127(3): 741–749
7. Jensen ME1, Gibson PG, Collins CE, Hilton JM, Wood LG. Diet-induced weight loss in obese children with asthma: a randomized controlled trial. Journal of the British Society of Allergy and Clinical Immunology.

In a Duke University study researchers found that Splenda may not be as healthy as previously thought, and may instead cause weight gain, kill beneficial intestinal bacteria and block the absorption of prescription drugs.

Over the course of 12 weeks, researchers gave varying dosages of Splenda to five groups of rats and then collected their fecal pellets. Though all of the rats consumed the same amount of food, the rats that received the Splenda treatment gained significantly more weight than the control group, and continued to do so even after treatment was stopped. “We found that the [sucrose] actually causes a decrease in the microflora,” said lead researcher Dr. Mohamed Abou-Donia, professor of pharmacology, cancer biology and neurobiology. “Generally, the microflora is responsible for the synthesis of vitamins and acts as protection from bad microbes.”

But Dr. Pao-Hwa Lin, assistant research professor of medicine, noted that the results of the study cannot necessarily be applied to humans, although he acknowledged that Splenda could interfere with some medications.

The company says that [Splenda] is derived from sugar, but there is some processing that is deriving this sucralose [and] we are not sure whether it is really safe or not,” she said. “However, [ the findings do ] need to be confirmed in humans.”

Because the study was performed on rats, some students said the results will not deter them from using the sugar substitute.

“The perception is that [artificial sweeteners] are healthier than pure sugar,” freshman Zhe Ma said, adding that he prefers their taste to that of sugar.

Although the study was funded by the Sugar Association, which lobbies for the national sugar industry and sued Splenda in 2004, Abou-Donia said the group was not involved in conducting or analyzing the study.

“I had the idea of doing the study, and asked the Sugar Association if they would fund it. They said yes,” he said. They did not, however, “have any input on the planning or performing [of ] the study, interpretation of the results or [the] writing of the [study],” he said.

In previous studies, researchers discovered that between 60 and 95 percent of ingested sucralose which is a component of Splenda is not absorbed from the gastrointestinal tract. Abou-Donia wanted to find out what this excess sucralose does in the gut.

The findings of the study were posted on The Journal of Toxicology and Environmental Health’s Web site.

Too much weight gain, too little exercise, bad eating habits, etc. account for the preponderance of cases of diabetes in Western countries.

Most authorities argue that diabetes is largely lifestyle related. Too much weight gain, too little exercise, bad eating habits, etc. account for the preponderance of cases of diabetes in Western countries. Overall, the American diet is mineral-poor. We as a nation are not fond of green leafy vegetables or of whole grains and, as a result, a majority of all Americans consume, for example, inadequate amounts of magnesium. Supplementation with magnesium in a recent trial with overweight subjects for four weeks supported the hypothesis that dietary magnesium plays a beneficial role in the regulation of insulin and glucose homeostasis.¹ Two other minerals of special importance for fending off diabetes are chromium and manganese.

Addressing the external influences on the rise of childhood obesity: Breastfeeding, Home Environment and Toddler Nutrition

The steady rise of obesity rates in America’s children should be a wakeup call for everyone, especially parents. Yet, it seems that those who should take the strongest course of action consistently ignore this growing epidemic. In a time when external factors make it more and more difficult to raise healthy children, it is important to recognize the environmental and nutritional aspects associated with childhood obesity. The common claim that, “he’s just big-boned” can only rationalize a child’s unhealthy weight so much. At some point parents need to look beyond genetics.

As a psychiatrist, I am clearly familiar with the psychodynamic issues underlying eating disorders, and I see psychotherapy as a vital part of treatment. At the same time, I would like to share my experience with observing and treating some of the biochemical underpinnings, hastening recovery and helping to maintain it as well.

Many years ago, a psychologist who specializes in eating disorders began to send me her clients because she had heard that antidepressant medications worked for these patients. I had by then shifted to a more holistic approach, so I told her that before I prescribed antidepressants, I wanted to try some more natural methods. I had discovered that in many cases of eating disorders, there is an underlying biochemical issue—a combination of food sensitivity, blood sugar imbalance and nutrient deficiency. She agreed, her patients cooperated, and we had some excellent, medication-free results. This encouraged me to continue on this natural path as I have to this day. Here are some of my discoveries, as well as subsequent research by others in this growing field.

Food Sensitivity
We crave the foods that we are sensitive or “allergic” too. Not a typical allergy with hives or stomach aches, these sensitivities are intolerances, often inherited, and show up in any number of ways—for example, depression, inability to lose weight, eating disorders, tinnitus, unexplained aches and pains—many, many others. The very foods we crave will create the most symptoms and are the most damaging. In fact, food cravings are similar to an addiction to alcohol. As you withdraw from the foods you're addicted to, you begin to have withdrawal symptoms and the cravings begin. And if you happen to be addicted to wheat or baked goods, you can never get enough of them, so you binge on them, despite your best intentions to the contrary. People addicted to grains may drink excessive amounts of grain-based liquor or beer and can become alcoholics. They're sensitive to and addicted to the alcohol, but it's the grain-base that is causing the problem. They can even feel “drunk” after eating cereal or baked goods. Not so different from your regular carb-binger, except the target is alcohol instead of refined carbs.

Nutrients

It's not just a matter of willpower. In order to break the addiction cycle, in addition to avoiding the undesirable foods, you have to supply the body with a good, supportive nutritional program of healthful food, vitamins, minerals, and amino acids. Then, the cravings will often simply go away! It's quite remarkable; with a nutrient rich diet, and good vitamin and mineral formula, you can stop the cycle. In fact, once the diet and nutrients are in place, the cravings and addictions will often just fall away. Remember that nutritional supplements are not a substitute for healthy food, but a supplement to restore missing ingredients and balance biochemistry.

Magnesium is often deficient, and taking it can be very helpful. It's great, too, for muscle tension, insomnia, and even, heart palpitations. The amino acid glutamine is also useful for reducing cravings. I've had former alcoholics (yes, former) say that the glutamine cut their cravings for good; they no longer were battling the desire to drink. They were done for good. Glutamine works similarly with bulimics and binge eaters.

Zinc: Some years ago, researcher Alex Schauss did a study on patients who were suffering from anorexia nervosa. By using a simple test called a zinc taste test, he found that they were zinc-deficient. He then gave them liquid zinc therapeutically, with very successful results. The test consists of the person taking some liquid zinc sulfate solution in their mouth, and if they describe it as having a bad or strong taste, they usually have sufficient levels of zinc. On the other hand, if they can't taste the solution or if it tastes just like water, then they may have a cellular zinc deficiency, even if their blood levels look adequate. It's a vicious cycle since zinc deficiency affects taste; so zinc-deficient anorexics don't taste their food, so are less motivated to eat it. Zinc supplementation has continued to be used in nutritionally oriented settings, including my own practice.

Serotonin: Bulimia and binge-eating is often treated with the SSRI antidepressants such as Prozac, Zoloft and Lexapro They raise brain levels of serotonin, a neurotransmitter or chemical messenger in the brain that causes a feeling of well-being and relaxation, and reduces hunger. Rather than using medication, my preference is to prescribe the materials that make serotonin, the amino acids L-tryptophan or it's relative, 5-HTP (5-hydroxytryptophane), and there is research to back it.

In her book, The Diet Cure, Julia Ross refers to a study where bulimics were deprived of tryptophan. In reaction, their serotonin levels dropped and they binged more violently, ingesting and purging an average of 900 calories more each day. In another study, adding extra tryptophan to the diet reduced bulimic binges and mood problems by raising serotonin levels. More recently, an Oxford researcher, Katherine Smith, reported that even years into recovery, bulimics can have a return of their cravings and mood problems after only a few hours of tryptophan depletion, concluding that, “Our findings support suggestions that chronic depletion of plasma tryptophan may be one of the mechanisms whereby persistent dieting can lead to the development of eating disorders in vulnerable individuals.”

The herb St. John's Wort provides another way to raise serotonin levels. I have discussed this along with dosages of tryptophan and other nutrients in my book, Natural Highs.

Thiamine: As we have seen, nutrient deficiencies can aggravate anorexia, and it should be treated with nutrient rich diets. For example, restricting your diet will make you deficient in such vitamins as vitamin B1 (thiamin). It's found in foods that people with eating disorders rarely eat—including beans, whole grains, seeds, meats and vegetables. Common signs of thiamine deficiency are loss of appetite, weight loss, constipation, anxiety, chest pain and even sleep disturbance along with depression and irritation. Sound familiar?

Blood Sugar Swings
One mechanism underlying the craving and eating (or drinking) cycle is blood sugar imbalance: low blood sugar sets off the craving. The brain experiences this dip as life-threatening starvation, followed by a frantic search for whatever will raise blood sugar. Just picture our ancestors in the jungle, short on food, and having to hunt for their next meal—or die. We, on the other hand, just go to the refrigerator. The quickest fixes here are sugary foods or other refined carbs such as bread or pastries. And we don't even burn any calories on our hunt.

Bottom Line: Treat Nutrient Deficiency with Nutrients
I will often order a blood test to see which amino acids are low. By replacing them the body (and brain) comes into balance. As a result the food cravings will often be greatly relieved or even come to a halt, as noted in the case of glutamine for acute cravings.

There are other natural treatments, as well, for cravings due to food sensitivities. Acupuncture and acupressure has been shown to help, especially some techniques such as NAET that can actually eliminate the food sensitivities themselves.

The point is, instead of simply taking an antidepressant, there are many other ways to approach what at first appears to be strictly a psychological problem. The combination of psychotherapy and a nutritional/biochemical approach is the most useful, and I have successfully treated many patients without resorting to medication at all. Not only does this approach work as well as medication but in my experience working with the body's chemistry, rather than introducing more chemicals in the form of medication, is often superior. It's faster, has none of the side effects, and has many side benefits. I developed Brain Recovery AM & PM formula to provide many of the nutrients mentioned here and more, to balance amino acids, serotonin, blood sugar, and mood.

For more information, see my books, Natural Highs, and 8 Weeks to Vibrant Health. Also sign up for my free e-newsletter, and get a free copy of my e-book, Reclaim Your Brain.

Because of the metabolic problems occurring in fibromyalgia and CFS, two in-house studies done in our research center showed an average 32 1/2 pound weight gain in this illness. As most of you have found, trying to lose this weight before one has addressed the underlying metabolic problems can be near impossible.

• 0.4 percent were underweight;
• 25.9 percent normal weight;
• 29.9 percent overweight;
• 43.8 percent obese.

When comparing the people with fibromyalgia who were obese with those who had normal weight, the study did find what we have often seen before as well. People suffering with obesity report higher prevalence of abuse (48 versus 33.9 percent, P = 0.016) and sexual abuse (17.3 versus 6.8 percent, P = 0.01) than those with normal weight.

My problem with the study? Although this study was well done, and I applaud the authors, their writing does reflect the general lack of understanding of this illness and the people who suffer with it. The study conclusion? "Physicians treating FM should discuss weight loss with their FM patients. Even if increasing BMI [weight] is not intrinsic to FM, it contributes to poor mood and functional outcome and should be a treatment goal."

As if most people with fibromyalgia who have weight issues haven't tried to lose weight!

So here are a few important points to keep in mind if you start hearing stuff related to this study:

1. Our studies showed that the average 32.5 pound weight gain occurred after the fibromyalgia symptoms began. In other words, the weight gain was triggered by the illness not the other way around.
2. The decreased metabolism likely directly contributes to the weight gain. Until this is addressed, it is unlikely that the person will be able to effectively lose weight. Just saying, "lose weight" without addressing these is setting the person up for failure. Key factors that must be addressed for the weight to be lost and the overall symptoms to improve are:

A. Optimizing thyroid function?even if the blood tests are "normal."

B. Optimizing adrenal function. Elevated cortisol can cause weight gain, and inadequate cortisol can cause sugar cravings and food cravings that trigger weight gain.

C. Optimize sleep. Sleep contributes to the production of growth hormone which increases muscle mass and lowers fat. Inadequate sleep is associated with an average 6 1/2 pound weight gain and 30 percent increased risk of obesity.

D. Treat the Candida. Candida overgrowth in the gut has clinically been shown to trigger sugar cravings, and the increased sugar intake can contribute to insulin resistance and weight gain. The sugar craving caused by low blood sugar (from adrenal fatigue) is an irritable "feed me now or I will kill you" kind of feeling. The sugar cravings from Candida are more what I characterize as "the happy Twinkie hunter," where you are happily going through the kitchen cabinets looking for something sweet. It is not uncommon in fibromyalgia to have both. When the underlying adrenal and Candida issues are addressed, not only will you feel dramatically better, but also the weight can come down and the sugar cravings resolve.

E. Begin a walking program. Many of us are afraid to exercise because of the postexertional crashing. Unfortunately, this lack of exercise results in deconditioning, which is devastating in this illness. So start a walking program, and wear a pedometer. Look to increase your walking by about 50 steps a day as able. See my article on Exercise Friend or Foe in Fibromyalgia? In the April2016 issue of TotalHealth for more information.

The free Energy Analysis Program at www.EnergyAnalysisProgram.com can analyze your symptoms, and even pertinent lab tests if available, to show you how to optimize energy production and metabolism in your case.

Please do not beat yourself up over the weight gain. It was out of your control. But now with understanding the causes, not only can you feel better, but the weight can also come down as well.

References:

1. http://www.medscape.com/viewarticle/851088?src=wnl_edit_tpal&uac=24960PZ

You don’t need to believe that “men are from Mars, women are from Venus” in order to accept that men and women have different nutritional needs. Men lead in eight of the top ten causes of death in the United States. As is often observed, because men are more reluctant than women to seek medical care, when they do so, their illnesses typically have advanced to a more serious degree. It would seem that men, even more than women, would do well to adopt defensive measures to preserve their health. Women are not only the fairer sex, but when it comes to health, they are in general, also savvier. However, men should not depend on the supplements used by their wives or women friends. Some preventative measures are strictly gender-specific. For example, whereas calcium and iron are good for women, these minerals may not be good supplement choices for men.

For men, the primary health issues today probably are cardiovascular disease and conditions affecting the prostate. Heart disease is the leading cause of death in men and prostate cancer is the seventh. Are matters improving? It is hard to tell. For instance, the incidence rate of prostate cancer went up in the period from 1995 to 2000, although the death rate appeared to have stabilized. Fortunately, the rate of lung cancer continues to decline. As for heart disease, our current emergency medical interventions are so effective that the death rate is declining. However, actual cardiovascular health is not improving—the rate of occurrence of first heart attacks is going up. How could it be otherwise? Obesity, diabetes and hypertension are all increasing. Diabetes in adults males over the age of 20 is estimated to now occur at a rate of 9.3 percent (data for 1999–2000) compared to 7.9 percent in the period from 1988 to 1994. For men aged 60 or over, the rate in 1999–2000 was roughly 19 percent. The following suggestions are designed to help men take charge of their health while the ball is still in their court.

Cardiovascular Disease
Cardiovascular health is a common topic of conversation. The reason, of course, is that heart disease in its various forms is the leading cause of death in adults and is especially prevalent in males. By age 60, one in five men will have already suffered a heart attack. The conditions to watch usually have been taken to be dysregulated blood lipids, homocysteine levels, hypertension, and obesity. More recently, it has been suggested that chronic low-level inflammation is a major causal factor in cardiovascular disease and that the Metabolic Syndrome (insulin resistance) is the actual underlying condition responsible for many or even most of the risk factors traditionally treated as indicators of heart and circulatory health.

Antioxidants, Essential Fatty Acids and Minerals
So-called “bad” cholesterol, low-density lipoprotein (or LDL), according to much current thinking, is only harmful if it has been damaged by oxygen and/or free radicals. Therefore, a protective program might include vitamin C (500 mg—2 grams daily) taken along with vitamin E as gamma-tocopherol (200 IU daily) and plant antioxidants. Tocotrienols, compounds from the same family as vitamin E, may be even more protective. A spate of studies have shown that the beneficial effects of vitamin E are much more pronounced in the gammatocopherol form and that vitamin E should not be supplemented alone, but rather in conjunction with vitamin C and the other antioxidants mentioned here. Indeed, many researchers now believe that the vitamin antioxidants are much more effective if used together and along with a variety of plant-derived antioxidants.

Grape seed extract (100–300 mg daily) is commonly used in Europe by individuals who experience vascular and general circulatory problems. According to epidemiological data, safe and effective means of reducing heart disease risks include the ingestion of many such flavonoids, catechins and other polyphenols found in fruit extracts and tea. With regard to tea, these benefits come not just from green tea, but also from the theaflavins found in black and oolong teas. Another set of plant compounds that support heart health are lignans. Flax is especially rich in lignans. Tea, of course, is a beverage and flax is a food. Other food sources being mined for special antioxidants include olives and various highly colored berries.

Similarly useful nutrients include the combination of L-carnitine (500–1,500 mg daily) and coenzyme Q-10 (30– 300 mg daily). Specialty forms of L-carnitine include L-carnitine fumarate, GPLC (glycine propionyl L-carnitine hydrochloride) and acetyl L-carnitine. Alpha-Lipoic acid (100–300 mg daily) is another good choice, and one with a particularly broad range of benefits. Minerals to supplement are chromium (200–600 mcg daily), magnesium (400 mg daily, preferably as magnesium aspartate) and selenium (200 mcg daily). A good broad-spectrum mineral supplement containing the Reference Daily Intake of copper should be considered if using the higher recommendation of vitamin C or if elevated triglycerides are a problem. Emerging evidence also supports supplementation with the lesser-known mineral silicon in the form of orthosilicic acid.

Of great importance, for instance, in controlling inflammation, is the right balance of fats in the diet. It is accepted by most researchers that the modern Western diet is very poor in the essential fats known as omega-3 fatty acids. Sources of omega-3 fatty acids are flaxseed oil (1–2 tablespoons daily) and fish oil capsules (follow manufacturers’ recommendations). Just how important are these oils? Well, when the fish-supplemented trials are removed from statistical analyses of the standard low-fat dietary interventions routinely touted in medical circles, the benefits with regard to heart disease are marginal and overall mortality rates actually increase! Gamma-linolenic acid (GLA, 100–300 mg daily) can be taken in conjunction with omega-3 fatty acids for further protection against inflammation and to maintain immune balance when large amounts of fish oils are ingested. Finally, to protect against elevated blood homocysteine levels, supplement with vitamin B-6 (15–50 mg daily), vitamin B-12 (250 mcg daily) and folic acid (400 mcg daily).

Prostate Health
What can go wrong with the prostate? Plenty. Prostate problems typically can be catalogued under four headings: prostatitis, prostatodynia, benign prostatic hyperplasia (BPH), and prostate cancer. Prostatitis is really a catch-all term for several types of prostate problems. It always involves inflammation of the prostate and may also include considerable pain, whereas BPH may not involve any pain (as opposed to discomfort). Prostatitis is fairly common in adult males. It sometimes has a bacterial infectious component, but it often has no clear cause. Abstaining from alcohol and spicy foods helps in some cases. Prostatodynia, which is most common in young and middle-aged men, often appears as pain and/or discomfort in the groin, perineum, testicles, lower back, and penis. Smooth muscle spasms in the prostatic portion of the urethra and in the neck of the bladder are at work here. Fatigue in the muscles in the pelvic region and emotional stress appear to be powerful contributory factors in prostatodynia.

Benign prostatic hyperplasia (formerly called hypertrophy) involves the renewed growth in the number of prostate cells late in life. Unfortunately, nearly 60 percent of men age 40 to 59 are likely already to suffer from BPH. This usually does not present a noticeable problem until after age 50, but by the age of 80, some 85 percent of all men suffer from one or more symptoms of BPH. The primary effect of BPH is a progressive decrease in the ability to empty the bladder as the prostate enlarges and applies pressure to the urethra. BPH should not be confused with prostate cancer,although there is an overlap of symptoms between the two. Men over age 50 should regularly visit their urologists to discover and distinguish between these two conditions. Fortunately, prostate cancer is one of the slowest growing of all cancers. Antioxidants, Essential Fatty Acids and Minerals

Prostate problems are far easier to prevent than to deal with after they have manifested. Moreover, especially in the case of prostate cancer, epidemiological studies routinely find that eating more fruit and vegetables is strongly protective, whereas consuming large amounts of milk (especially more than two glasses per day) appears to have a strongly negative effect upon prostate health. Studies suggest that supplementing with vitamin E (200 IU daily), lycopene (5–10 mg daily), and the minerals selenium (400 mcg daily) and zinc (15 mg daily) are good protective measures. Flaxseed oil (1–2 tablespoons daily) can be quite beneficial, as can the regular consumption of pumpkin seeds. Men should avoid margarine, hydrogenated vegetable oils and fried foods whenever possible. The jury is still out with regard to the effects of calcium supplementation in men. Some epidemiological studies indicate that higher intakes of calcium are correlated to higher risks of prostate cancer, perhaps through a negative effect upon the levels of active vitamin D in the body or through some other mechanism. The work of E. Giovannucci of Harvard Medical School has been instrumental in uncovering the calcium/prostate cancer connection and the protective effects of fruit consumption nd an adequate intake of vitamin D (but not more than 400 IU daily).

Isoflavone Herbal Preparations
Although it may surprise most men, many of the same isoflavones and phytoestrogens that are helpful to women are also helpful to men. Men and women both produce estrogen. As males age the ratio of testosterone to estrogen is reduced. This reduced ratio of testosterone to estrogen appears to be the key cause of prostate problems. Plant estrogens, which are very weak in comparison with the estrogen itself, can actually reduce the impact of hormonal estrogen at the level of cell receptors. Isoflavones found in soybeans and red clover represent a promising approach to prostate health management. Also useful are extracts of saw palmetto berries and flower pollen. Indeed, specialty flower pollen extracts (from mostly rye pollen) have an unusually broad range of benefits for the prostate in that they have proven to be useful not only in cases of BPH, but also in prostatitis and prostatodynia.

Stress
Prolonged stress poses a very real health risk, one with which men are less physiologically equipped to cope than are women. Higher rates of heart disease and high blood pressure are but two results. In the pre-modern world, many or even most threatening or challenging situations (“fight or flight” situations) led to a physical response which consumed and directed the energy made available by the release of hormones such as epinephrine into the blood stream. Physical responses, however, are not usually possible or even desirable in the face of stalled traffic or office frustrations. In such cases, the released energy is “bottled up,” as it were. This results in disturbances in sleep, immune function, blood pressure regulation and other bodily systems. As the “fight or flight” reference suggests, the best responses to stress are often physical. Try to get some vigorous physical exercise every day, but also consider practicing yoga or some similar form of relaxing physical therapy.

Nutrients and Herbs for Relaxation
Generalized emotional and physical stress leads to oxidative stress. Therefore, a broad-spectrum antioxidant mixture is an excellent countermeasure. Be sure to include in the diet, as well, the recommended daily intake of all of the B vitamins. The amino acids taurine (500 mg to 1 gram daily) and glutamine (750 mg to several grams daily) play important roles in the body’s response to stress. These are best utilized if taken between meals with a small carbohydrate snack. The bioflavonoid known as chrysin (1–3 grams daily) is an important stress-reducing compound, as are theaflavin, valerian and skullcap (see manufacturers’ directions). Also useful are calming herbal teas. The best known of these is chamomile.

Sports Aches and Pains of the Weekend Warrior
Exercise is important. In some studies, men who exercised regularly had a 70 percent reduced risk of death from all causes and a 39 percent reduced risk of death from heart attack. This is the good news. The bad news is that those of us who are sedentary for five days out of the week and then try to make up for this in the remaining two days of the weekend may find that we end up with more than our share of aches and pains. The body responds best to regular exercise, which is to say, exercise at least every other day. Cramming a week’s worth of exercise into the weekend is asking for trouble. And, of course, as we get older our ability to “bounce back” from strenuous physical exertion diminishes. Fortunately, there are some ways to prevent problems and to help make them go away once they develop.

Antioxidants
Conditioned athletes are actually able to produce more of certain antioxidant enzymes within their bodies to cope with this heightened demand, and this fact indicates that training may produce a type of “reserve capacity” for antioxidants. However, it is still true that exercise puts oxidative stress on the body. In various studies, athletes who ingested an antioxidant “cocktail” before working out experienced faster recovery and fewer aches and pains than those who did not take the antioxidants. The daily antioxidant intake might include vitamin C (500 mg–2 grams), vitamin E (100–200 IU as gammatocopherol), coenzyme Q-10 (30–300 mg), alpha-lipoic acid (100–300 mg), plus a number of plant antioxidants, such as mixed citrus bioflavonoids (1,000–3,000 mg). Individuals who are involved in contact sports might consider either grape seed or pine bark extracts (200–300 mg) to help prevent bruising. Glutamine (750 mg to several grams daily) recently has become one of the favored supplements by serious athletes because of its benefits in recovery and in sparing the destruction of lean tissues due to excessive exertion.

Nutrients for Repair
Ligament and cartilage injuries are common in sports. Glucosamine and chondroitin sulfate are often recommended in osteoarthritis to improve the repair of cartilage, and these compounds can also be used to speed up repair—or to improve general resilience—of the joints, ligaments and tendons in sports. (Follow manufacturers’ directions.) Sadenosylmethionine (SAMe) is another nutrient that improves tissue repair and indirectly reduces pain and inflammation; the dosage is typically 400–800 mg of SAMe per day. Expect to wait from one to four weeks to experience the benefits of these supplements if you are just starting to use them. These items improve the body’s ability to heal itself and are not directed at symptoms as such.

Hair Loss
Roughly one half of the men in Western industrialized countries suffer from Male Pattern Baldness (MPB), and this syndrome accounts for some 90 percent of all cases of hair loss. However, the presence of MPB does not mean that other factors are not at work, such as reduced circulation. For instance, increases in hair loss in certain areas of the scalp correlate with the development of heart disease. For example, extreme thinning specifically on top of the head (rather than merely receding from the front) appears to be more strongly associated with circulatory disease than is balding elsewhere on the head. Hence, this problem is not always cosmetic and concern may not be limited to vanity.

Hair Nutrients
Deficiencies in the B vitamins biotin, inositol, pantothenic acid, and PABA are particularly linked to hair loss and to premature graying. A number of nutritionists have suggested that high-potency supplementation with the entire range of B vitamins, with special attention paid to biotin, inositol and pantothenic acid, may prove to be helpful. Vitamin C (1–2 grams daily) is important for the circulation, but also for the production of collagen, a component of the hair. Coenzyme Q-10 (30–300 mg daily) is another antioxidant often suggested to improve scalp circulation. Alpha-lipoic acid (100–300 mg daily) similarly appears to be effective and seems to be useful in hair loss if supplemented for at least six months. The amino acid cysteine (1–3 grams daily), also supplemented as Nacetyl-cysteine (NAC, 500–750 mg daily), can help to increase the speed at which the hair grows. A new and really interesting item that improves the quality of the hair is choline-stabilized orthosilicic acid (BioSil)—it is worth a shot. No major improvements in scalp health or hair loss should be expected in less than three months’ time (the hair follicles need to be activated and the hair must grow out). For many men, increasing protein in the diet may also prove useful in increasing the rate at which the hair grows. This may reflect an effect upon thyroid function, in which case, adding omega-3 fatty acids to the diet is also a good idea.

Conclusion
Men’s nutritional needs differ from those of women. It is not difficult however, to meet these special needs. A well-structured program of nutritional insurance should include as a foundation a balanced multivitamin/mineral supplement. Then plan in advance to provide nutritional support for any special needs. As always, it is recommend that you tell your doctor or health care provider what supplements or herbs you are taking. Even if he or she is not overly familiar with them, this knowledge is useful for monitoring your health.

Obesity has gone prime time. We Find evidence of its presence where ever we look: in every neighborhood, every mall, every school and every workplace. Hardly a day goes by without the news reporting on some aspect of the looming obesity crisis. However, the epidemic is not confined to just the wealthy developed world. Even desperately poor countries such as Nigeria and Uganda are wrestling with the dilemma of obesity. China, which was once one of the world’s leanest countries, is not immune. In fact, it has one of the fastest-growing obesity rates in the world and one quarter of its urban youth is presently overweight. It is projected that by 2015, 200 million Chinese will be not just obese, but morbidly obese. The looming obesity epidemic is sending chills through the global community. Worldwide, more than 1.3 billion people are overweight, whereas only 800 million are underweight—and these statistics are diverging rapidly.

The problem of expanding waistlines is more than merely a vanity concern. There are serious health consequences from sporting that beer belly. Being overweight can radically change the course of a person’s life. Fat is toxic and potentially lethal. Just carrying as few as an extra 4.5 kilos (10 pounds), over your ideal weight is considered a serious risk factor for heart disease, diabetes, high blood pressure, dementia and Alzheimer’s disease, liver disease, hormonal imbalances depression and cancer. In fact, at least 30 different diseases are related to being overweight. So, what’s going on here? If people were to follow the advice offered by medical professional, public health officials and the experts from the weight loss industry, the problem should be easily solved. Their call to action basically involves turning your back on all those sugary, high carbohydrate, processed, junk foods and switch to a low calorie diet fortified by plenty of exercise. They say it all boils down to a very simple equation: take in fewer calories and burn more.

Sounds logical. The only problem is that this decades old approach is a dismal failure. For the vast majority of people, it doesn’t work. In fact, long-term success for attaining permanent weight loss is only achieved by a mere 2–5 percent of those very determined and lucky dieters.

A definition of insanity is doing the same thing over and over again and expecting a different outcome. It certainly appears that the traditional approach to winning the battle of the bulge does indeed, seem insane.

If there are answers and successful strategies to stem the tide of this serious health epidemic, they will need to be sought elsewhere.

It’s time to discover some of the missing pieces of the weight loss puzzle.

Secrets of the Brain-Belly Connection
Do you value your brainpower? Certainly the one faculty that everyone wants to hold onto throughout a life’s lifetime is a fully functioning, intact brain. Unfortunately belly fat can deliver a serious blow to your aspirations.

Overwhelming evidence now reveals that your expanding waistline will put a serious crimp on your brain size as well as brainpower.

Researchers set out to discover if being overweight posed a danger to the brain. They scanned the brains of 94 people over the age of 70. They were looking to see the differences in the brains of people who were of normal weight (BMI under 25), overweight (BMI 25–30), and obese (BMI over 30). (BMI stands for body mass index, an approximation of body fat based on height and weight.)

Their results were quit shocking. Overweight people have 4 percent less brain tissue than people of normal weight. And, for obese people, the findings were even worse. They had 8 percent less brain tissue than people of normal weight.

The study not only showed that carrying extra weight degenerated the brain but it also accelerated its aging. Researcher Paul Thompson shared his observation, “The brains of overweight people looked eight years older than the brains of those who were lean, and 16 years older in obese people. Type 2 diabetes, which is common in the overweight, is known to accelerate the aging of the brain and the onset of dementia. But the relationship between brain size and weight still stood when the researchers accounted for this, suggesting it is the fat itself that is causing the problem. It is thought that high levels of fat raise the odds of the arteries clogging up, cutting the flow of blood and oxygen to the brain. This could cause brain cells to die and the organ to shrink.” The high demands put on these brain areas may make them more sensitive to changes in oxygen levels.

Another study used magnetic resonance imaging to compare the brains of 44 obese individuals with those of 19 lean people of similar age and background. The obese individuals had more water in the amygdale—a part of the brain involved in eating behavior. It also showed smaller orbitofrontal cortices in obese individuals, important for impulse control and also involved in eating behavior. These findings strengthen the “slippery slope” theory of obesity. The neural changes that occur when you are overweight, affects the parts of your brain that influence and control so many behaviors necessary to make healthy choices.

Further studies indicate that those with the most belly fat (visceral fat mass) suffer the greatest mental declines over time—and that central or abdominal obesity, in particular, accounts for more than a three-fold increase in dementia risk.

What’s even more worrying is that increased belly fat is linked to decreases in total brain volume, independent of BMI. This can cause changes in another area of the brain, called the hippocampus, which is responsible for long-term memory, spatial memory and navigation. Finally, excess belly fat also appears to contribute to lesions in the brain’s white matter, especially in diabetic patients—linking it not just to memory loss, but also to increased risk of stroke.

Obesity is also causes changes to the immune system, which are fanning the flames of inflammation throughout the body. This increased inflammation can impact the brain and lead to a vicious cycle of gaining more and more weight: obesity leads to inflammation, which damages certain parts of the brain, which in turn leads to more uncontrolled eating and more obesity.

There are many areas of the brain that are affected by being overweight.

• Frontal and temporal lobes—critical for planning, memory and impulse control
• Anterior cingulate gyrus—responsible for attention and executive functions
• Hippocampus—important for long-term memory, spatial memory and navigation
• Basal ganglia—essential for proper movement and coordination

Here is the catch-22. Those extra kilos impair brain function and compromise the particular areas of brain that impact a person’s ability to have a keen memory, control impulses and follow through on any kind of planning. It, therefore, becomes more difficult to successfully commit to any kind of program, especially a weight loss program. Since the impulse control part of the brain is affected, controlling those urges to help yourself to another donut or a second helping of mashed potatoes is a Herculean effort and generally doomed to fail.

Vitamin D —A Key to a Healthy Metabolism
There is one really important nutritional player when it comes to our health. This superstar nutrient is the sunshine hormone, vitamin D. (Vitamin D is really a steroid hormone rather than an actual vitamin.)

Vitamin D truly deserves the title of superstar. Each year, vitamin D research discovers additional health benefits conferred by this sunshine vitamin. Vitamin D receptors are found throughout the body including the brain. Optimal levels are absolutely necessary to insure healthy bones, healthy arteries, a robust immune system, balanced moods, optimal cognitive function, protection from hypertension, allergies, multiple sclerosis, Alzheimer’s disease, autoimmune conditions, and fertility and PMS. Most significantly, vitamin D has been proven to be protective against 13 different kinds of cancer.

Optimal Levels of Vitamin D Are Critical for Health Here are some basic facts you need to know about vitamin D. It is a fat-soluble steroid hormone that is both made by the body and from our diet. In order for the body to produce vitamin D (cholecalciferol), the skin must be exposed to ultraviolet light, primarily from the sun. Vitamin D is further metabolized in the liver and kidneys to create the fully active form of vitamin D. Thus variations in sun exposure due to latitude, season, time of day, sunscreen use, skin pigmentation, and age will determine how much vitamin D the body makes.

Although it is known that vitamin D play a vital role for the well-being of infants, children, adults and the elderly, we presently have a global pandemic of chronically low vitamin D levels. It’s estimated that 85 percent of the American public are deficient, and as much as 95 percent of all its senior citizens. Vitamin D deficiencies are also widespread throughout the UK, with 86 percent of the population deficient in the winter and 57 percent in the summer.

Even though Australia’s is described as “sun burnt” country and is one of the sunniest countries in the world, a surprising number of its citizens are severely lacking in vitamin D. A recent report stated that as many as 1 in 3 Australians may have low vitamin D levels.

For all those on a weight loss quest, vitamin D is one of those missing pieces you have been searching for. There is overwhelming evidence that confirms the importance of keeping your vitamin D levels up to get your extra kilos down. Not only does it help achieve weight loss, it also improves other risk factors such as insulin resistance, metabolic syndrome and blood sugar imbalances. If you are feeling hungry all the time no matter how much you eat, you might want to have your vitamin D levels checked. What drives insatiable hunger is the relationship between low vitamin D levels and a hormone called leptin. Leptin is a messenger molecule made in fat cells that communicates to the hypothalamus, letting it know how much fat is stored in the body. It is the hormone that communicates that you are full.

Low vitamin D levels interfere with the effectiveness of leptin. Researchers at Aberdeen University, Scotland found that obese people produced 10 per cent less vitamin D than people of average weight. The study discovered that low levels of the vitamin in blood interfered with the function of leptin, which tells the brain when the stomach is full. The study also found that excess body fat absorbs vitamin D, stopping it from entering the bloodstream. Dr Helen MacDonald, of Aberdeen University’s department of medicine and therapeutics, said: “Obese people had less vitamin D and the link between obesity and vitamin D deficiency was statistically significant.” Overweight people, shirking the sun or not taking adequate vitamin D supplementation thwart their dieting efforts in another way. Low vitamin D levels have been shown to increases fat storage. A 2009 Canadian study found that weight and body fat were significantly lower in women with normal vitamin D levels than women with insufficient levels.

It seems that fat people may be less able to convert vitamin D into its hormonally active form. A Norway study found that the more participants weighed, the lower their vitamin D levels tended to be. The researcher, Zoya Lagunova, MD, believes that obesity is associated with lower vitamin D levels since vitamin D is a fat-soluble vitamin. “Much of the vitamin D produced in the skin or ingested is distributed in fat tissue, so obese people may take in as much vitamin D from the sun, food, or supplements as people who are not obese, but their [blood] levels will tend to be lower. Obese people may need more vitamin D to end up with the same levels as a person whose weight is normal.”

How much less vitamin does an overweight person make? As it turns out, increased fatty cells can decrease the ability to make vitamin D by a factor of 4. That means that if you are carry extra weight, you may make only one quarter the amount of vitamin D compared to a leaner person. Vitamin D is also an important factor in diabetes. Low levels of vitamin D has been linked to an increased risk of developing type 2 diabetes. After following more than 5,000 people for five years, an Australian research team found that those with lower than average vitamin D levels had a 57 percent increased risk of developing diabetes, compared to those within the recommended range.

Low levels of vitamin D are also known to nearly double the risk of cardiovascular disease if you already have diabetes. Diabetics, who are deficient in vitamin D and cannot process cholesterol normally, tend to have it build up in their blood vessels, hence increasing the risk of heart attack and stroke.

Vitamin D also helps keep blood sugar levels under control. In type 2 diabetes the body can’t use insulin it produces efficiently to control blood sugar levels. Vitamin D plays a role by increasing the release of insulin. In one study, researchers evaluated the vitamin D levels and the chance of developing unbalanced blood sugar metabolism. In this study, subjects were evaluated for serum vitamin D levels and followed for 7 years to determine the effects on blood sugar metabolism. The study showed that the subjects with the highest vitamin D levels had a 40 percent increase in supporting optimal future blood sugar balance.

If you want to lose weight and keep it off, it is critical to check your vitamin D levels. The higher your vitamin D levels the higher your leptin levels and the more your blood sugar will remain balanced. Vitamin D helps your body respond to the correct metabolic messages. High vitamin D levels increase your ability to lose weight and losing weight will increase your vitamin D levels. All of which will reduce your risk of metabolic syndrome, insulin resistance, diabetes, and cardiovascular disease, not to mention most chronic illnesses.

While it is important for most people to take vitamin D supplementation, especially the overweight, children and elderly, it is critically important to check your vitamin D levels. Taking a vitamin D supplement may not get you into optimal range, which is where you want to be. Its optimal blood vitamin D levels that count. The proper blood test is called 25-hydroxyvitamin D (25-OH), which is included in the basic blood workup. In Australia optimal levels should be 150–200 nmol/L. In the U.S., optimal levels should be between 70–100 ng/mL. Do not settle for less than optimal levels if your goal is the best health possible.

It is New Year's resolution time and one of the perennial resolutions for many Americans is, "this year I am going to lose weight and keep it off."

Literally two thirds of Americans are overweight or worse, so there are a lot of such resolutions being made. Like gym memberships, however, there are far more resolutions initially undertaken than followed through. Nevertheless, this time around things can be different. One key is that the weight loss strategy adopted should also be one that can be continued as a normal everyday diet pattern. There is no reason that this should not work as long as realistic goals are adopted. Life, as the observation goes, is a marathon, not a sprint. Moderate, yet well thought-out changes in the diet regarding the ratios of protein, carbohydrate and fat can yield durable results over a span of three to six months. Similarly, care in terms of the timing of food intake, consumption of fiber and phytonutrients, and so can yield big rewards.

High Protein Beats High Carbohydrate During Weight Loss

Let's start with the initial weight loss goal. Ads for diet products and programs often promise "ten pounds in ten days," but such promises, even were they true, are never lasting. The body resists extreme changes and, in the end, the body always wins. A better approach is to coax the body in the desired direction so that it becomes more metabolically flexible and thus can burn fat for energy rather than storing it. This means overcoming roadblocks such as poor blood sugar control dieting-induced loss of lean tissue. The protein-to-carbohydrate make-up of meals is important here. Indeed, this ratio and not the amount of fat in the diet is determining.

Realistically, reducing energy intake by approximately 500 calories per day is sufficient for many dieters initially to experience weight loss of 1 – 2 pounds per week. The catch is that weight loss based only on restricting calories has a poor record for improving impaired glucose tolerance and typically leads to a loss of the more actively calorie-metabolizing lean body tissues. A study with obese subjects published in the journal BMJ Open Diabetes Res Care demonstrates that this need not be the outcome of dieting.¹ One hundred percent of obese adults using a high protein (HP) moderately calorically-restricted diet, but not those on a similarly restricted high carbohydrate (HC) diet achieved a return to normal glucose tolerance in addition to benefits in their markers for cardiovascular and inflammatory health. On the HP diet there was an increase in the percentage of lean body mass and a decrease in the percentage of fat body mass with weight loss whereas the HC diet led to a decrease in the percentage of lean body mass along with a decrease in the percentage of fat body mass. The change in glucose tolerance/blood sugar levels and the improvement in the percent lean body mass demonstrated with higher protein intake and restricted carbohydrate intake are highly desirable outcomes. The key was substituting protein for carbohydrate calories.

For this study, researchers randomized 24 women and men with elevated fasting glucose levels in the pre-diabetic range to either a HP diet (30 percent protein, 30 percent fat, 40 percent carbohydrate; n=12) or a HC diet (15 percent protein, 30 percent fat, 55 percent carbohydrate; n=12) for a study lasting six months. All meals were provided to these subjects for the six months. At the start of the study and at its conclusion, tests were performed to determine oral glucose tolerance and serum insulin levels as well as a variety of other parameters indicative of metabolism and inflammation. X-ray scans were conducted to determine body composition in terms of the percentage of lean and fat tissue.

The differing diets led to dramatically different results. According to the authors of the paper, on the HP diet 100 percent of the subjects exhibited remission of their pre-diabetes to normal glucose tolerance whereas only 33.3 percent of subjects on the HC diet exhibited this remission. Moreover, the high protein arm subjects exhibited significant improvement in (1) insulin sensitivity (p=0.001), (2) cardiovascular risk factors (p=0.04), (3) inflammatory cytokines (p=0.001), (4) oxidative stress (p=0.001), and (5) increased percent lean body mass (p=0.001) compared with the HC diet.

In terms of the findings likely to be of particular interest to most dieters, it should be pointed out again there was an increase in the percentage of lean body mass and decrease in the percentage of fat body mass with weight loss on the HP diet. In contrast, there was a decrease in the percentage of lean body mass with weight loss on the HC diet although the percentage of fat body mass did decline as expected. Importantly, both metabolic parameters and inflammation markers were improved only on the high protein / reduced carbohydrate, moderately calorically restricted diet.

Doesn't Eating Fat Make You Fat?
Keeping weight off after a diet is the real challenge. The fact that in dieting it is mostly the caloric restriction that leads to weight loss and not diet specifics has been known for decades.² For instance, in 1996 a study was published that compared diets much more disparate than the one described above.³ Forty-three obese adults were randomly assigned to receive diets containing 1,000 calories/day composed of either 32 percent protein, 15 percent carbohydrate, and 53 percent fat or 29 percent protein, 45 percent carbohydrate, and 26 percent fat. There was no significant difference in the amount of weight lost. Nevertheless, just as in the study above, fasting plasma glucose, insulin, cholesterol, and triacylglycerol concentrations decreased significantly in patients eating low-energy diets that contained 15 percent carbohydrate, but neither plasma insulin nor triacylglycerol concentrations fell significantly in response to the higher carbohydrate diet.

A more recent study looked at moderate energy intake on a very high-fat, low-carbohydrate (73 percent of energy from fat, 10 percent of energy from carbohydrate and 17 percent of energy from protein) or low-fat, high-carbohydrate (30 percent of energy from fat, 53 percent of energy from carbohydrate and 17 percent of energy from protein) diet for 12 weeks.⁴ Unlike most modern diets, these were diets involving only minimally processed carbohydrates and fats. Despite expectations, the high fat diet did not raise LDL cholesterol; however, it did raise HDL cholesterol. According to one of the co-authors of the study, "the very high intake of total and saturated fat did not increase the calculated risk of cardiovascular diseases." "Participants on the very-high-fat diet also had substantial improvements in several important cardiometabolic risk factors, such as ectopic fat storage, blood pressure, blood lipids (triglycerides), insulin and blood sugar."⁵

Therapeutic diets usually restrict either carbohydrates or fats. If fats are restricted, then the diet will tend towards an increased protein content. Most dieters will find that in the early stages, this high intake of protein will reactivate the thyroid and make life easier. There is plenty of clinical evidence to the effect that high protein snacks reduce calorie intake more than do snacks of carbohydrate, fat or alcohol for overweight individuals accustomed to the usual American mixed diet. And increasing protein intake to 25 percent of calories clinically has been demonstrated to increase both weight loss (by 75 percent) and fat loss (by 57 percent) more than was found on a protein intake of 12 percent. Still, eating protein is not a panacea (too much is too much⁶) and protein needs to be matched with goodly intakes of fruit and vegetables as well as the avoidance of refined carbohydrates for best results. Moreover, decades of research, as indicated above, demonstrates that carbohydrates need to be replaced by protein for best results.

Does Gut Bacteria Play a Role in Weight Regain?
Preserving lean tissue and improving various metabolic parameters certainly help to make dieting results more stable and lasting. An additional factor, one seldom considered, is the role of gastrointestinal bacteria in weight maintenance. Human experiments have demonstrated that changing the diet to artificially induce blood sugar regulation issues surprisingly quickly results in changes in the gut microbiome that cause these bacteria to release more calories from food than normally would be the case, for instance, by digesting supposedly indigestible fiber. Similarly, it is well established that individuals who are overweight, obese and/or diabetic often have substantially different gut microflora than individuals who are lean.⁷ Therefore, so-called yo-yo dieting and recurrent obesity might be at least influenced by the microbes found in the gut.

A recent report in Nature casts further light on an aspect of this issue.⁸ As observed by one of the authors, Dr. Eran Elinav from the Weizmann Institute of Science in Israel, "we've shown in obese mice that following successful dieting and weight loss, the microbiome retains a 'memory' of previous obesity." Co-author Professor Eran Segal elaborated, "this persistent microbiome accelerated the regaining of weight when the mice were put back on a high-calorie diet or ate regular food in excessive amounts." One of the findings of this research is that the post-diet gut biome destroys certain flavonoids from the diet that influence energy metabolism. This interferes with energy release from fat. In post-dieting mice this leads to an accumulation of extra fat when they are returned to a higher-calorie diet. Experimentally, according to the paper, "flavonoid-based 'post-biotic' intervention ameliorates excessive secondary weight gain." This suggests that microbiome-targeting approaches may help with weight regain.

Putting It Together
Diets similar to the 30 percent protein, 30 percent fat, 40 percent carbohydrate diet described above have been proposed for several decades.⁹ In addition, the role of phytonutrients now is strongly supported. Both these aspects of good meal planning need to be addressed. A simple approach to meals is to make sure that roughly one third of the plate is covered with a protein source and one half or even two thirds of the meal plate is covered with the lightly cooked vegetable of your choice (salad does not count here; corn and carrots are counted as carbohydrates). Always eat this vegetable serving, which should be at least two cups of vegetables. Eat protein before eating any carbohydrates in the main meal for better digestion and better appetite control. (Classic European, Chinese and Japanese meal planning often arranges protein courses before carbohydrate courses.) Remember that vegetables are perfectly good carbohydrate sources and may well be consumed in the place of concentrated carbohydrates, such as rice and potatoes. Dieters also should consider supplementing with probiotics in conjunction with prebiotics. Finally, as noted in previous TotalHealth articles, when meals are eaten may be as important and what is eaten; never skip breakfast and avoid eating late in the evening or before bedtime.¹⁰

1. 1. Stentz FB, Brewer A, Wan J, Garber C, Daniels B, Sands C, Kitabchi AE. Remission of pre-diabetes to normal glucose tolerance in obese adults with high protein versus high carbohydrate diet: randomized control trial. BMJ Open Diabetes Res Care. 2016 Oct 26;4(1):e000258.
2. 2. Sacks FM, Bray GA, Carey VJ, Smith SR, Ryan DH, Anton SD, McManus K, Champagne CM, Bishop LM, Laranjo N, Leboff MS, Rood JC, de Jonge L, Greenway FL, Loria CM, Obarzanek E, Williamson DA. Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. N Engl J Med. 2009 Feb 26;360(9):859–73.
3. 3. Golay A, Allaz AF, Morel Y, de Tonnac N, Tankova S, Reaven G. Similar weight loss with low- or high-carbohydrate diets. Am J Clin Nutr. 1996 Feb;63(2):174–8.
4. 4. Veum VL, Laupsa-Borge J, Eng Ø, Rostrup E, Larsen TH, Nordrehaug JE, Nygård OK, Sagen JV, Gudbrandsen OA, Dankel SN, Mellgren G. Visceral adiposity and metabolic syndrome after very high-fat and low-fat isocaloric diets: a randomized controlled trial. Am J Clin Nutr. 2016 Nov 30. pii: ajcn123463. [Epub ahead of print]
5. 5. University of Bergen. "Saturated fat could be good for you, study suggests." ScienceDaily. ScienceDaily, 2 January 2017. www.sciencedaily.com/releases/2016/12/161202094340.htm.
6. 6. Rietman A, Schwarz J, Tomé D, Kok FJ, Mensink M. High dietary protein intake, reducing or eliciting insulin resistance? Eur J Clin Nutr. 2014 Sep;68(9):973–9.
7. 7. Zhang Q, Wu Y, Fei X. Effect of probiotics on body weight and body-mass index: a systematic review and meta-analysis of randomized, controlled trials. Int J Food Sci Nutr. 2015 Aug;67(5):571–80.
8. 8. Thaiss CA, Itav S, Rothschild D, Meijer M, Levy M, Moresi C, Dohnalová L, Braverman S, Rozin S, Malitsky S, Dori-Bachash, M. Kuperman Y, Biton I, Gertler A, Harmelin A, Shapiro H, Halpern Z, Aharoni A, Segal E, Elinav E. Persistent microbiome alterations modulate the rate of post-dieting weight regain. Nature. 2016 Nov 24. doi:10.1038/nature20796.
9. 9. Sears B, Ricordi C. Anti-inflammatory nutrition as a pharmacological approach to treat obesity. J Obes. 2011;2011.
10. 10. Sellix MT. For Management of Obesity and Diabetes: Is Timing the Answer? Endocrinology.2016 Dec;157(12):4545–9.

Solving the Mystery of the Multivitamin Part III

This article is the third in the series begun with “Solving the Mystery of the Multivitamin” and continued with “The Special Nutritional Needs of Women.” Here it is observed again you do not need to believe “men are from Mars, women are from Venus” in order to accept that men and women have different nutritional needs. Men lead in eight of the top ten causes of death in the United States. As it is often remarked, because men are more reluctant than women to seek medical care, when they do so, their illnesses typically have advanced to a more serious degree. It would seem that men, even more than women, would do well to adopt defensive measures to preserve their health. However, men should not depend on the supplements used by their wives or women friends. Some preventative measures are strictly gender-specific. The following suggestions are designed to help men take charge of their health while the ball is still in their court.

Well, it’s the New Year! Perhaps you’ve made a resolution to lose weight. If so, good for you. Of course you know and I know that it’s not that simple. For those of us who have struggled with the battle of the bulge, we know for a fact that losing weight isn’t easy. Furthermore, one of the primary reasons that this is so has to do with appetite control. Simply put, if you’re not hungry it’s easy to lose weight. If you’re not hungry you can keep your calorie consumption down, feel satisfied and easily fit into your jeans. Unfortunately, that elusive sense of satiety is hard to come by for so many overweight and obese individuals.

What would really help is something that safely and effectively helped to reduce appetite and promote satiety. Of course there are many products out there claiming to do just that. The fact is, however, that the overwhelming majority of them just don’t seem to work. The sad truth is there is no magic weight loss pill—despite marketing claims to the contrary. The good news is there are two commonly available substances that can help with appetite control and satiety. These substances are not the miracle answer to weight loss, but they may very well be able to help you with the process. These two common substances are fiber and protein—or more specifically, a certain type of fiber and protein.

Oligofructose-enriched inulin: a preferred fiber
In general, fiber is known for its ability to help suppress appetite. The way it works is that fiber absorbs water or other liquids and expands in the stomach, helping to create a full feeling. While this is generally true of any fiber, there are some types that perform better than others for this purpose. One such type, derived from Chicory root, is oligofructose and oligofructose-enriched inulin (OEI). Both oligofructose and inulin are soluble fibers, and oligofructose is also identified as a functional fiber, which means it has additional beneficial physiological effects in humans.¹

In a double-blind, randomized, placebo-controlled, crossover trial² thirty-six overweight and obese men and women consumed either 12g/day OEI or placebo for three weeks, as two 6g supplements dissolved in a beverage, with breakfast and lunch. The result was the subjects using the OEI consumed significantly less calories. In another randomized double-blind, cross-over study,³ 31 healthy men and women received 10g oligofructose, 16g oligofructose or 16g placebo daily for 13 days. The result was that the subjects consumed significantly less calories with 16g/ day oligofructose. In a third randomized, double blind, parallel, placebo-controlled trial,⁴ a total of 10 healthy adults received either 16g/ day OEI or 16g/ day placebo for two weeks. Results showed that the OEI treatment lowered hunger rates and ate less calories than the placebo group. Additional studies have shown similar results.^5,6,7,8 Furthermore, other research has shown that supplementation with OEI provided additional benefits: it helped improve calcium absorption^9,10,11,12 and it acted as a prebiotic that promoted the growth of healthy bifidobacteria probiotic colonies in the gut.^13,14,15,16

WHEY PROTEIN
Multiple studies¹⁷ have shown that increasing the protein content of meals without increasing total calories has resulted in subjects eating less overall calories. Furthermore, other studies¹⁸ have shown that a higher protein intake increases thermogenesis (i.e. fat burning) and satiety compared to diets of lower protein content. Some evidence suggests that diets higher in protein result in an increased weight loss and fat loss as compared to diets lower in protein.

While almost any protein source could offer satiety enhancing benefits, whey protein (WP) has been shown to be particularly effective for this purpose, as well as providing other benefits that may help support weight loss. One of the mechanisms by which it does this is that it delays gastric emptying more effectively than other forms of protein tested. In other words, it keeps food in the stomach longer so you feel fuller for a longer period of time.¹⁹ Other research²⁰ has shown that WP was more effective than other forms of protein tested at reducing the amount of fat in the blood stream after meals in obese individuals. This not only bodes well in helping to decrease cardiovascular disease risk, but lowering blood fats is also conducive to supporting weight loss goals.

With regard to reducing appetite and improving satiety, there are so many studies that it is not practical to review them in this article. Instead, I’ll just provide the accompanying summary table below.

CONCLUSION
Losing weight can be difficult, especially when your appetite gets in the way. However, if you use some fiber and protein before a meal, you may be able to “spoil” your appetite on purpose, allowing you to eat less and feel satisfied—which is likely to bode well for your weight loss efforts.

References:

1. Slavin J. Fiber and Prebiotics: Mechanisms and Health Benefits. Nutrients. 2013 Apr; 5(4): 1417–35.
2. McCann MT, Livingstone MBE, Wallace JMW, Gallagher AM, Weich RW. T1:P.082 Oligofructose-enriched Inulin supplementation decreases energy intake in overweight and obese men and women. Obes Rev. 2011;12 (Suppl. 1): 86–7.
3. Verhoef SP, Meyer D, Westerterp KR. Effects of oligofructose on appetite profile, glucagon-like peptide 1 and peptide YY3-36 concentrations and energy intake. Br J Nutr. 2011 Dec;106(11):1757–62.
4. Cani PD, Lecourt E, Dewulf EM, Sohet FM, Pachikian BD, Naslain D, De Backer F, Neyrinck AM, Delzenne NM. Gut microbiota fermentation of prebiotics increases satietogenic and incretin gut peptide production with consequences for appetite sensation and glucose response after a meal. Am J Clin Nutr. 2009 Nov;90(5):1236–43.
5. Cani PD, Joly E, Horsmans Y, Delzenne NM. Oligofructose promotes satiety in healthy human: a pilot study. Eur J Clin Nutr. 2006 May;60(5):567-72.
6. Hume M, Nicolucci A, Reimer R. Prebiotic Fiber Consumption Decreases Energy Intake in Overweight and Obese Children. FASEB J. 2015;29(1):S597.3.
7. Parnell JA, Reimer RA. Weight loss during oligofructose supplementation is associated with decreased ghrelin and increased peptide YY in overweight and obese adults. Am J Clin Nutr.2009 Jun;89(6):1751–9.
8. Daud NM, Ismail NA, Thomas EL, Fitzpatrick JA, Bell JD, Swann JR, Costabile A, Childs CE, Pedersen C, Goldstone AP, Frost GS. The impact of oligofructose on stimulation of gut hormones, appetite regulation and adiposity. Obesity (Silver Spring). 2014 Jun;22(6):1430–8.
9. Holloway L, Moynihan S, Abrams SA, Kent K, Hsu AR, Friedlander AL. Effects of oligofructose-enriched inulin on intestinal absorption of calcium and magnesium and bone turnover markers in postmenopausal women. Br J Nutr. 2007 Feb;97(2):365–72.
10. Abrams SA, Griffin IJ, Hawthorne KM, Liang L, Gunn SK, Darlington G, Ellis KJ. A combination of prebiotic short- and long-chain inulin-type fructans enhances calcium absorption and bone mineralization in young adolescents. Am J Clin Nutr. 2005 Aug;82(2):471–6.
11. Griffin IJ, Davila PM, Abrams SA. Non-digestible oligosaccharides and calcium absorption in girls with adequate calcium intakes. Br J Nutr. 2002 May;87 Suppl 2:S187–91.
12. van den Heuvel EG, Muys T, van Dokkum W, Schaafsma G. Oligofructose stimulates calcium absorption in adolescents. Am J Clin Nutr. 1999 Mar;69(3):544–8.
13. Gibson GR, Beatty ER, Wang X, Cummings JH. Selective stimulation of bifidobacteria in the human colon by oligofructose and inulin. Gastroenterology. 1995 Apr;108(4):975–82.
14. Rao VA. The prebiotic properties of oligofructose at low intake levels. Nutr. Res. 2001;21(6):843–48.
15. Langlands SJ, Hopkins MJ, Coleman N, Cummings JH. Prebiotic carbohydrates modify the mucosa associated microflora of the human large bowel. Gut. 2004 Nov;53(11):1610–6.
16. Evelyne M Dewulf, Patrice D Cani, Sandrine P Claus, et al. Insight into the prebiotic concept: lessons from an exploratory, double blind intervention study with inulin-type fructans in obese women. Gut. 2013 Aug; 62(8): 1112–21.
17. Yang D, Liu Z, Yang H, Jue Y. Acute effects of high-protein versus normal-protein isocaloric meals on satiety and ghrelin. Eur J Nutr. 2014;53(2):493–500.
18. Halton TL, Hu FB. The effects of high protein diets on thermogenesis, satiety and weight loss: a critical review. J Am Coll Nutr. 2004 Oct;23(5):373-85.
19. Stanstrup J, Schou SS, Holmer-Jensen J, Hermansen K, Dragsted LO. Whey protein delays gastric emptying and suppresses plasma fatty acids and their metabolites compared to casein, gluten, and fish protein. J Proteome Res. 2014 May 2;13(5):2396–408.
20. Holmer-Jensen J, Mortensen LS, Astrup A, et al. Acute differential effects of dietary protein quality on postprandial lipemia in obese non-diabetic subjects. Nutr Res. 2013 Jan;33(1):34–40.
21. Marsset-Baglieri A, Fromentin G, Airinei G, Pedersen C, Léonil J, Piedcoq J, Rémond D, Benamouzig R, Tomé D, Gaudichon C. Milk protein fractions moderately extend the duration of satiety compared with carbohydrates independently of their digestive kinetics in overweight subjects. Br J Nutr. 2014 Aug 28;112(4):557–64.
22. Arciero PJ, Baur D, Connelly S, Ormsbee MJ. Timed-daily ingestion of whey protein and exercise training reduces visceral adipose tissue mass and improves insulin resistance: the PRISE study. J Appl Physiol(1985). 2014 Jul 1;117(1):1–10.
23. Pal S, Radavelli-Bagatini S, Hagger M, Ellis V. Comparative effects of whey and casein proteins on satiety in overweight and obese individuals: a randomized controlled trial. Eur J Clin Nutr. 2014 Sep;68(9):980–6.
24. Chungchunlam SM, Henare SJ, Ganesh S, Moughan PJ. Effect of whey protein and glycomacropeptide on measures of satiety in normal-weight adult women. Appetite. 2014 Jul;78:172–8.
25. Acheson KJ, Blondel-Lubrano A, Oguey-A raymon S, et al. Protein choices targeting thermogenesis and metabolism. Am J Clin Nutr. 2011 Mar;93(3):525–34.
26. Pal S, Ellis V. The acute effects of four protein meals on insulin, glucose, appetite and energy intake in lean men. Br J Nutr. 2010 Oct;104(8):1241–8.
27. Akhavan T, Luhovyy BL, Brown PH, Cho CE, Anderson GH. Effect of premeal consumption of whey protein and its hydrolysate on food intake and postmeal glycemia and insulin responses in young adults. Am J Clin Nutr. 2010 Apr;91(4):966–75.
28. Veldhorst MA, Nieuwenhuizen AG, Hochstenbach-Waelen A, et al. Dosedependent satiating effect of whey relative to casein or soy. Physiol Behav. 2009 Mar 23;96(4-5):675–82.
29. Bowen J, Noakes M, Clifton PM. Appetite regulatory hormone responses to various dietary proteins differ by body mass index status despite similar reductions in ad libitum energy intake. J Clin Endocrinol Metab. 2006 Aug;91(8):2913–9.
30. Bowen J, Noakes M, Trenerry C, Clifton PM. Energy intake, ghrelin, and cholecystokinin after different carbohydrate and protein preloads in overweight men. J Clin Endocrinol Metab. 2006 Apr;91(4):1477–83.
31. Vandewater K, Vickers Z. Higher-protein foods produce greater sensoryspecific satiety. Physiol Behav. 1996 Mar;59(3):579–83.

Few people are surprised when told that it is relatively hard to lose weight in the fall heading into winter and relatively easy to lose weight in the spring. This is not just a matter of Thanksgiving, Christmas, New Year’s and the Super Bowl, although the grouping of these holidays hardly helps. Our bodies exhibit metabolic changes in preparation for the winter months and then tend to reverse at least some of these changes as the next year progresses. Hibernation is the classic example of these changes, but seasonal fluctuations in metabolism are shared by a quite large proportion of all mammals in temperate climates, including humans. More surprising to most of us is the fact that similar fluctuations in energy use and storage are tied to the twenty-four hour (circadian) cycle, as well, and these fluctuations are so strong that they may be more important than the usual dietary suspects — the amounts of carbohydrate, fat and protein in the diet — that typically are the targets of dietary advice.

The Day/Night Cycle Exists Even For Genes
A few years ago, a team of researchers experimented to learn if circadian rhythmic patterns apply to human fat tissue.¹ In this particular case, they wanted to know if genes related to cortisol metabolism exhibited such rhythms in adipose tissue. (Cortisol is sometimes called the “fight or flight” hormone; it also plays a large role in weight gain.) Sure enough, the scientists found rhythmicity in cells from both men and women and in fat cells both from under the skin (subcutaneous) and around the abdomen (visceral deposits), with the amplitude of the circadian rhythmicity being greater in the visceral fat tissue genes.

Yet another circadian pattern involving cortisol is important for weight gain in those under mild chronic stress, including the stress associated with diabetes. Under normal circumstances, the body tends to have a period of time during inactivity — our sleep cycle — in which cortisol levels in the blood exhibit a prolonged “trough” of reduced presence. Mild stress may only slightly elevate the total daily glucocorticoid level, yet still alter the way in which tissue receptors respond. In an animal model, healthy animals after several days of added glucocorticoid (via pellets under the skin) showed reduced adrenal and thymus weight, i.e., adrenal exhaustion and reduced immune response, and elevated insulin levels.² This would seem to be similar to early stage Metabolic Syndrome as the animals struggle to regulate the excess sugar being released into the system by the glucocorticoid. In diabetic animals, insulin levels drop dramatically with continued glucocorticoid challenge, which means that the ability to regulate blood sugar also drops. Conversely, food intake and blood triglycerides increase in diabetic animals versus controls. Chronic exposure to cold in this model has the same type of effect as does added glucocorticoid, including the same disruption of the circadian rhythm of reduced glucocorticoid during the rest period. As the authors of this study observe, “studies in man suggest that perceived chronic stress also flattens the amplitude of the circadian cortisol rhythm by elevating trough and reducing peak levels; subjects who reported increased stress were abdominally obese, hyperinsulinemic and hypertensive.”

With the foregoing evidence in mind, it is easy to grasp that activities such as exercise and meal timing may play significant roles in body weight and health. Hunger levels, the ability to dispose of meal calories and the degree of metabolic response, including metabolizing excess calories, all respond to stress levels and the timing of activities.

Calorie Storage Depends On Meal Times
It has been known for several decades that the composition of the initial meal of the day tends to set the body’s response to food intake later in the day. Not eating breakfast, for instance, tells the body that it should reduce energy expenditures and conserve in the face of famine conditions. Eating refined carbohydrates and sugars causes an insulin release that blocks fat metabolism, forces the body to rely on stored glycogen for energy and leads to energy peaks and valleys, the blood sugar “roller coaster.” Protein breakfasts including either fat or carbohydrates tend to even out energy levels and retain what is known as “metabolic flexibility,” the ability to harness either glucose or stored fat for fuel as needed.

A good example of the meaning of meal timing in practice emerged recently in several trials using animal models. Mice and rats are extremely sensitive to the level of fat in their diets, in part because their natural diets are very low in fats. Unlike humans, both animals eat more or less continuously during their waking periods of activity. Either high- or low-fat diets spread throughout their normal 12-hour feeding period exercise limited effects on food intake and energy usage. Under these conditions, the animals generally adjust consumption and expenditure to maintain balance and metabolic parameters within normal ranges. Feeding a high-fat meal at the beginning of the feeding period does not alter metabolic flexibility and, again, the animals adjust. However, the same high fat meal taken at the end of the animals’ waking period leads to increased “weight gain, adiposity, glucose intolerance, hyperinsulinemia, hypertriglyceridemia, and hyperleptinemia” independent of either total or fat-derived calories.³ The major surprise, one that runs counter to common assumptions, is this finding: “We report that high fat feeding at the transition from sleeping to waking appears to be critically important in enabling metabolic flexibility and adaptation to high carbohydrate meals presented at later time points. Conversely, high carbohydrate feeding at the beginning of the waking period dramatically impairs the metabolic plasticity required for responding appropriately to high fat meals presented at the end of the waking period.” In other words, the standard American breakfast of sweetened cereal or other refined carbohydrate products impairs the ability of the body to properly metabolize fats eaten later in the day.

Other researchers have found similar results. Again in a mouse model, one group found that a diet sufficiently high in fat to induce weight gain and related changes if fed ad libitum did not lead to such changes if restricted to a limited feeding period.⁴ Not caloric restriction or fat restriction, but a restricted feeding period led to favorable results. “Timed restricted feeding provides a time cue and resets the circadian clock, leading to better health.” Simply put, a timed high-fat diet resets circadian metabolism and prevents obesity in this mouse model despite the high-fat content in an animal that normally consumes very little fat.

What About Humans?
A number of recent clinical experiments have confirmed the findings from these animal models as being applicable to humans, with increased protein consumption at breakfast proving to be especially helpful. For instance, in overweight/ obese, “breakfast-skipping” late-adolescent girls, breakfast, and especially a high protein breakfast led to better appetite control, better regulation of food intake and reduced evening snacking compared to not eating breakfast even though in this short study (one week) there was no change in total energy intake.⁵

Another study, this one in overweight and obese adults, found that both a low-carbohydrate breakfast (not specifically high in protein) and a high-protein plus carbohydrate breakfast led to impressive weight loss over a period of 16 weeks (15.1±1.9kg and 13.5±2.3 kg, respectively) when followed in conjunction with reduced energy intake. After the diet ended, subjects were tracked for a further 16 weeks. As is found commonly in such models, there was significant weight regain in the lowcarbohydrate only breakfast group compared to the protein plus carbohydrate arm.⁶ This finding should surprise no one in that it is easier to add protein to more “normal” meal patterns than it is to radically reduce carbohydrates. Low-carbohydrate diets tend to lead to considerable rebound as dieters return to their normal eating habits. People who have increased their protein consumption along with changing other eating habits find it easier to continue some version of their new eating pattern.

Yet another study, this one restricted to overweight and obese women, found that in a restricted calorie diet (~1,400 kcal) the results were significantly better at the end of 12 weeks in the women who ate a large breakfast (700 kcal breakfast, 500 kcal lunch, 200 kcal dinner) as opposed to a large dinner (200 kcal breakfast, 500 kcal lunch, 700 kcal dinner).⁷

Eating breakfast, especially one that is higher in protein, has been found again and again to be superior to skipping breakfast or eating a breakfast built around carbohydrates. The shake out in meal composition revolves much more around the role of protein than fat because fats actually play a somewhat neutral role. As one paper’s title runs, “Carbohydrate-restricted diets high in either monounsaturated fat or protein are equally effective at promoting fat loss and improving blood lipids.”⁸ The primary difference is that in those who are overweight or obese, as opposed to in individuals who are lean or normal weight, fat has less satiating power than does protein.⁹ Otherwise, as long as high-fat consumption is not a marker for generally poor eating and exercise habits (low consumption of fruits and vegetables, low consumption of fiber, high consumption of sugars and refined carbohydrates), fat consumption, after 60 years of controversy, has not been shown to be innately a threat to health.¹⁰ Just remember that the foods eaten at breakfast tend to determine the body’s ability to retain metabolic flexibility later in the day. Breakfasts that container significant fat do not tend to interfere with the ability to metabolize fat rather than store it later in the day, breakfasts built around carbohydrates do, and protein is the great equalizer.

Conclusion
Whether it concerns mice or men, the timing of meals is important. Eating more at breakfast and less at the evening meal leads to better appetite control and better metabolic functioning along with better weight control. Eating more protein and fewer carbohydrates at the morning meal, likewise, leads to greater metabolic flexibility later in the day. The standard American breakfast of cold, sweetened cereal is a very poor choice for control of appetite, energy levels or body weight. Fats are a largely neutral in this picture, although they certainly can replace a good portion of carbohydrates, especially if more protein is consumed. The old adage to “breakfast like a king, lunch like prince and sup like a pauper” turns out to be good advice. Best of all, changing the timing and size of meals is free!

1. Hernandez-Morante JJ, Gomez-Santos C, Milagro F, Campión J, Martínez JA, Zamora S, Garaulet M. Expression of cortisol metabolism-related genes shows circadian rhythmic patterns in human adipose tissue. Int J Obes (Lond). 2009 Apr;33(4):473–80.
2. Dallman MF, Akana SF, Bhatnagar S, Bell ME, Strack AM. Bottomed out: metabolic significance of the circadian trough in glucocorticoid concentrations. Int J Obes Relat Metab Disord. 2000 Jun;24 Suppl 2:S40–6.
3. Bray MS, Tsai JY, Villegas-Montoya C, Boland BB, Blasier Z, Egbejimi O, Kueht M, Young ME. Time-of-day-dependent dietary fat consumption influences multiple cardiometabolic syndrome parameters in mice. Int J Obes (Lond). 2010 Nov;34(11):1589–98.
4. Hatori M, Vollmers C, Zarrinpar A, DiTacchio L, Bushong EA, Gill S, Leblanc M, Chaix A, Joens M, Fitzpatrick JA, Ellisman MH, Panda S. Time-restricted feeding without reducing caloric intake prevents metabolic diseases in mice fed a high-fat diet. Cell Metab. 2012 Jun 6;15(6):848–60.
5. Leidy HJ, Ortinau LC, Douglas SM, Hoertel HA. Beneficial effects of a higher-protein breakfast on the appetitive, hormonal, and neural signals controlling energy intake regulation in overweight/obese, “breakfast-skipping,” late-adolescent girls. Am J Clin Nutr. 2013 Apr;97(4):677–88.
6. Jakubowicz D, Froy O, Wainstein J, Boaz M. Meal timing and composition influence ghrelin levels, appetite scores and weight loss maintenance in overweight and obese adults. Steroids. 2012 Mar 10;77(4):323–31.
7. Jakubowicz D, Barnea M, Wainstein J, Froy O. High caloric intake at breakfast vs. dinner differentially influences weight loss of overweight and obese women. Obesity (Silver Spring). 2013 Dec;21(12):2504–12.
8. Luscombe-Marsh ND, Noakes M, Wittert GA, Keogh JB, Foster P, Clifton PM. Carbohydrate-restricted diets high in either monounsaturated fat or protein are equally effective at promoting fat loss and improving blood lipids. Am J Clin Nutr. 2005 Apr;81(4):762–72.
9. Brennan IM, Luscombe-Marsh ND, Seimon RV, Otto B, Horowitz M, Wishart JM, Feinle-Bisset C. Effects of fat, protein, and carbohydrate and protein load on appetite, plasma cholecystokinin, peptide YY, and ghrelin, and energy intake in lean and obese men. Am J Physiol Gastrointest Liver Physiol. 2012 Jul;303(1):G129–40.
10. Schwingshack L, Hoffmann G. Comparison of effects of long-term low-fat vs high-fat diets on blood lipid levels in overweight or obese patients: a systematic review and metaanalysis. J Acad Nutr Diet. 2013 Dec;113(12):1640 – 61.

We’ve heard about our school nutrition programs banning sugary beverages because of the immediate need to combat childhood obesity—currently in epidemic proportions in the U.S. That said, there’s a sneaky legal way manufacturers are using to offer reduced-calorie milk drinks like chocolate milk, for example. The ban was placed on added sugar or high fructose corn syrup but wait until you read what the industry is up to!

The claims that labeling like “reduced-calorie,” “reduced-sugar,” “low-calorie” or “diet” are terms that “turn-off” kids and teens has given way to another way of marketing to this demographic. According to FDA regulations, any “non-nutritive” additive in food must be boldly listed on the front label as well as included in the ingredient list. Because non-nutritive additives actually change the composition of the food or drink, the FDA does not allow drinks, for instance, to simply be called “milk” or “chocolate milk,” but must be labeled as “low-calories” or “reduced calorie.”

AND…believe it or not, the dairy industry believes that milk products lower in sugar but sweetened with aspartame is a healthier choice for our kids…REALLY?

How Milk Can Contribute to Obesity
It has been scientifically reported that whole milk can contribute to weight gain, heart disease and even diabetes. It’s also a known fact that removing that fat from whole milk products reduces the flavor…so…hence a perfect opportunity for manufacturers to add artificial sweeteners to low-fat products!

A study from The Physicians for Responsible Medicine (PFRM) reported in Archives of Disease in Childhood that low-fat milk did not lower obesity rates among children. In fact, kids that drank one percent or skim milk were more likely to be overweight or obese than those that drank whole milk!

As if those facts aren’t enough, researchers found that artificial sweeteners can, and usually do, change the chemistry of our brain and the satiation receptors—adding to cravings for sweets and high carb foods that convert to sugar.

When we consume refined sugars or artificial sweeteners, our brains actually believe we’re getting nutrients—we’re not, instead, increased appetite and food cravings are triggered. Our bodies aren’t actually looking for more sweetness, they’re looking for real food; hence the cravings.

You Should Know…
“There was a 41 percent increase in risk of being overweight for EVERY can or bottle of diet soft drink consumed.”

“Artificial Sweeteners increased caloric intake, body weight and body fat percentage.” AND…in a rat study, cocaine-addicted rats actually chose saccharin-sweetened water above and beyond cocaine-doses—even when the researches upped the drug levels! Artificially-sweetened food and drink actually modifies the taste buds—creating more cravings for sweets and simple carbohydrates.

Growing Strong
Parents have been led to believe that milk at school is a must in order to insure strong, healthy bones for growing children. A Harvard study, however, found that drinking milk doesn’t prevent the risk of bone fracture in women and recent studies found drinking milk doesn’t even prevent fractures in adolescent girls. For those reasons, PFRM believes milk should actually be taken off the school menu. On another note, milk fat is what helps the body absorb calcium—stripping the fat and pasteurizing the milk prevents us from adequately absorbing its nutrients, hence the health benefits. This occurs because pasteurization destroys phosphatase—an enzyme we’d normally use to take-up calcium. I don’t believe that pasteurized milk should be labeled as real milk, much less low-fat milk containing aspartame. If we as parents educate ourselves in reading labels and teach our children to eat and appreciate real foods, we won’t have to worry about the food industry trying to sabotage us by attempting to pass-off altered food as real food.

Chemical Cuisine: Do You REALLY Know What You’re Eating? The following are some of the most common (and most dangerous) food additives used today.

Acesulfame K
This brand-new artificial sweetener is 200 times sweeter than sugar. Little research has been done yet but early studies have linked it with certain cancers, migraines, vision disturbances, and thyroid disorders.

Artificial Flavoring
Artificial flavoring can mean that a food or beverage contains any one of 3,000 allowable chemicals, many of which have negative health effects. One of the toxic chemicals that can be legally hidden under this labeling is monosodium glutamate (MSG).

Aspartame (Equal™, NutraSweet™)
Aspartame is 180 times sweeter than sugar. The FDA file of complaints concerning aspartame ingestion includes reports of dizziness, headaches and memory loss. Some studies strongly suggest it is a carcinogen—an Excitotoxin that stimulates brain cells to death.

Benzene
The bottling process of many beverages produces benzene—it is a noted carcinogen linked to heart rate issues, infertility and seizures.

Cyclamates
Cyclamates are among the first artificial sweeteners used in diet drinks. They were once banned by the FDA because of suspicion of their link to cancer but they are once again up for FDA approval!

Food Coloring
Many food colorings are linked to ADD/ADHD, asthma and cancer. Although several of these are banned in other countries, the U.S. commonly makes use of Blue #1 and #2, FD & C colors, Ponceau, Red 2 (Amaranth), Red #3 (Erythrosine), Red #40 (Allura Red), Tartrazine, Yellow #2G, Yellow #6 (Sunset Yellow), Yellow #23 (Acid Yellow).

Saccharin (Sweet n’ Low™)
Saccharin is 300 times sweeter than sugar. The public stopped purchasing products made with the sweetener when they learned of its possible link to cancer. Studies didn’t ‘prove’ this link, so it is once again common in many artificially-sweetened foods. Saccharin is linked, however, to addiction to sweetness, obesity and overeating.

Sucralose (Splenda™)
Sucralose is 600 times sweeter than table sugar and is half refined sugar and half chemical. Sucralose was an accidental discovery— it was originally part of a new insecticide compound…oh great! Chlorinated compounds, such as sucralose, were thought to pass through the body undigested. Recent research, however, found that up to 40 percent of chlorinated compounds become stockpiled in the intestinal tract, soft and connective tissues, kidneys and liver. AND…chlorine has been classified as a carcinogen.

Reversing the Addiction
We can reverse our addiction to unhealthy sweeteners and restore our ability to taste the natural sweetness in whole foods… but…it takes time and commitment to a life-style change. It will seem difficult at first, but I can’t encourage you more strongly to put down the diet sodas and the colored sweetener packets! These chemicals are foreign to our bodies and will not help you achieve any of your health goals. They are actually documented Excitotoxins (they stimulate neurons to death), as eloquently described and researched in a book titled, ExcitoToxins: The Taste that Kills by Dr. Russell Blaylock.

Replace artificial sweeteners (and refined sugars, high fructose corn syrup, etc.) with natural sweeteners like stevia, xylitol (use in small amounts as it may cause some GI symptoms), sweeteners made from LoHan, and small amounts of agave nectar or raw honey. LoHan is my personal favorite—it is a no calorie, natural sweetener from an Asian gourd vegetable that resembles an acorn squash. In my opinion, it has the best taste and aroma as it smells and tastes like granulated maple syrup! You will want to make sure you use a high quality brand that has not been overly processed. LoHan is also a great option for people dealing with diabetes, as it will not spike your blood sugar levels and does not feed health-depleting yeast (Candida). In the long run, your best bet is to limit even these natural sweeteners so that your body’s cravings, food triggers and metabolism are restored to healthy functioning.