Arizona Sun Family Medicine

Weight loss, Fat Loss, and Voodoo

2011-08-26T19:18:00.000-07:00

It has been awhile since my last post. When I started this blog, it was my intention to post monthly. But such are things with life. I post today after my workout. But before I get to that, let me tell a little story.

Over the last 2 ½ years I have changed my diet. I was changed forever after reading Dr. Gundry’s Diet Evolution. Since then I have read many other books/blogs. Those include The Paleo Diet, Good Calories Bad Calories, The Perfect Health Diet, Bulletproofexec, and The 4 Hour Body among others. I have also been collecting journal articles reading about as much of the research that I can.

The main thing I surmised is that it is key to keep insulin levels even (mostly by controlling carbohydrate intake in both quantity AND quality), adequate fiber intake when eating carbohydrates to buffer the insulin response, and fat can be your friend and has been wrongly demonized.

Back to my “story”. The problem recently has been that I had reached a plateau in my weight loss efforts. In addition I just got back from vacation and was about 5 lbs above the baseline I had been over the previous six months. So what did I do? Like every other person does, I hit the gym. So for two months I did cardio 4-5 x a week with some weights, mixed in with some hot yoga. But results were not forthcoming and I was getting frustrated. I had actually gained 2 pounds (not sure if this was fat or muscle or both).

Then my gym started a 90 day challenge. So I thought to myself, what the heck, I know it was pretty much a scam to get me to by more services (which of course I did), but I thought that a challenge is what I needed. Recommit! I hooked up with a trainer, 2 x a week. He asked what my main goal was, and I obviously pointed to my gut and said “I want to get rid of this”. He said not a problem, but you are not going to like me very much. What ensued was a brutal high intensity workout 2 days a week with cardio/spinnning or hot yoga on off days. 90 days later I was down about 5 lbs and had lost about 2% body fat. Not quite the results I was looking for, but it was a start. I thought my nutrition was good, but I know it was not perfect. About 1 month ago, I had come across a blog called the Whole9. On their site, they mentioned something called the Whole30 challenge. Basically you eat whole, unprocessed foods for 30 days, including no alcohol and processed carbohydrates. Again, I was up for the challenge. Re-recommit! Well, my 30 days are almost up and I must say I have been impressed. After 3 weeks I had lost 9 lbs and decreased body fat by about 3-5%, all with only working out 2-3 x a week (very little cardio).

Here are my observations. They are specific for me and are not intended to be extrapolated to other individuals (see #9).

1. I must stay under 100 grams of carbohydrates in order to continue my weight loss. On days I go over 100 grams I either stay even or gain weight, no matter my calorie count!

2. During the 30 days I did not actively “count” calories (although I did log them along with wearing my Fitbit). My daily calorie intake ranged from 1400-2500 calories a day.

3. Eggs are my friend.

4. I LOVE the grass fed beef I purchased locally (I went in on 1/3 of a cow).

5. I need to eat this way for the rest of my life, not just 30 days, Duh!

6. Post prandial blood glucose never went above 125 at the 1 hour mark or 2 hour mark.

7. Counting calories is imperfect because food labels are imperfect.

8. If I “carb crave” in the evening then I have not eaten enough fat during the day.

9. Self-quantification is important. Collect data about your body then make changes from the data you obtain. The definition of insanity is doing the same thing over and over again and expecting different results. Weigh daily, check blood sugar and blood pressure regularly, track activity (Fitbit or Bodybugg), track your sleep (Fitbit or Zeo Sleep Coach).

I am most interested in my lipid, metabolic, and inflammatory markers. My hs-CRP, Lp-PLA2 and MPO were already low, but several markers of insulin resistance (IR) were elevated. I performed a baseline in April and will have them re-drawn next week. I will post results.

Nutrition, weight loss, and muscle gain are a complex machinery and it is even trickier in the setting of IR. About 70% of patients I treat have some form of IR, along with some form of lipoprotein abnormality. IR is really the source of most people’s issues that I treat. Until this is addressed, pathology (cardiovascular disease) will continue to ensue. I see this in patients day in and day out. I firmly believe carbohydrate restriction is a major piece of the puzzle and continue to recommend this for my patients with IR.

In the meantime, I will continue my low carb, moderate fat ways as it is working for me as it has for countless others.

Use of Artificial Sweeteners Increases Body Fat

2011-04-21T20:18:00.000-07:00

There has been conflicting stories about the use of artificial sweeteners, especially diet sodas. A recent article suggest drinking diet soda does not increase the risk of diabetes (http://tinyurl.com/43j3dck). Well here is some research to suggest that artificial sweeteners can actually increase body fat, which can be a risk factor for Type 2 Diabetes and the Insulin Resistant Syndrome. This is from the Colgan Institute (http://colganinstitute.com/index.php?main_page). So maybe think twice before you decide to guzzle down that next diet soda.

The main sugar substitutes are saccarin (Sweet'N Low), aspartame (Equal,NutraSweet), sucralose (Splenda, Altern) and acesulfame potassium. Sorbital and maltitol are used in "no sugar " ice cream and candy. Erythritol is the most recent, xylitol, cyclamate, and stevia are common. Despite their minimal to zero calories, they all make you put on body fat.
They pile on the pudge for simple physiological reasons. Sweet tastes in the mouth, and in the gut, induce an appetitive response by the brain, and an insulin response by the pancreas.(1-3) Because the artificial sweeteners are much sweeter than sugar, the response is larger than if you use sugar. Insulin is a prime storage hormone. The extra insulin will store as fat all the extra calories you eat because of the appetitive response induced but not satisfied by the chemical sweetener. Studies show definitively that both rats and people fed artificial sweeteners, put on more weight than if they used the equivalent amount of sugar.(1-3)
The artificial sweetener industry does not like being told that they are contributing to the rampant adult-onset diabetes and obesity in the US and Canada. And their ads claim the opposite. But if you examine the science, you will never use an artificial sweetener again.

1. Yang Q.Gain weight by "going diet?" Artificial sweeteners and the neurobiology of sugar cravings: Neuroscience 2010. Yale J Biol Med. 2010 Jun;83(2):101-8.
2. Brown RJ, de Banate MA, Rother KI.Artificial sweeteners: a systematic review of metabolic effects in youth. Int J Pediatr Obes. 2010 Aug;5(4):305-12.
3. Margolskee,R, et al. T1R3 and gustducin in gut sense sugars to regulate expression of Na+-glucose cotransporter 1 PNAS 2007 104: 15075-15080

Yeaaa! We're number one again!!!

2011-02-06T19:34:00.000-08:00

Unfortunately, this number 1 ranking is something that we should not be proud about. Congratulations to the US for being the fattest nation in the world. Latest statistics show that our average body mass index is over 28 (25-29.9 is overweight and over 30 is obese).

I am always amazed at the charts on obesity on the CDC website over the last 20 years (http://www.cdc.gov/obesity/data/trends.html#State) . It is shocking.

This article has charts from the World Health Organization:

http://www.dailymail.co.uk/news/article-1353761/U-S-home-fattest-men-women-Western-World.html

Yet, the "Food-Industrial Complex", continues to dupe the masses with fancy marketing and deceptive food labels.

I just saw this ad on the TV yesterday regarding high fructose corn syrup:

http://www.youtube.com/watch?v=EEbRxTOyGf0

Well, if you have 1 1/2 hour to kill, I HIGHLY recommend spending the time watching this presentation "Sugar: The Bitter Truth" by Robert H. Lustig MD. He is a Endocrinologist at UCSF. I think he does an elegant job of talking about sugar in the diet and particularly fructose.

Sorry to be a downer on Super Bowl Sunday, but as I tell my patients, "it is, what it is".

Metabolic Syndrome and Cognitive Function

2011-02-04T21:29:00.000-08:00

Bordeaux, France - People with the metabolic syndrome were significantly more likely than others to experience a decline in cognitive function, independent of previous cardiovascular disease, depression, or APOE genotype, in a study of generally healthy adults aged 65 and older who were followed for four years [1]. In particular, hypertriglyceridemia and low HDL-cholesterol levels were associated with declines in global cognitive function, and diabetes was associated with deteriorating memory.

"Our study sheds new light on how metabolic syndrome and the individual factors of the disease may affect cognitive health," first author Dr Christelle Raffaitin (French National Institute of Health Research, Bordeaux, France) noted in a statement on the study from the American Academy of Neurology. The report was published online February 2, 2011 in Neurology.

"Our results suggest that management of metabolic syndrome may help slow down age-related memory loss or delay the onset of dementia." to read more click the link

http://www.theheart.org/article/1181423.do

My comments:

The data keeps coming in how detrimental the metabolic syndrome and insulin resistant cholesterol pattern is in terms of risk for disease beyond the heart. I feel it is very important to look for insulin resistance. The key is identifying it early and educating my patients of the risk to their health. This way a plan of action can be formulated.

Those markers of insulin resistance can include acanthosis nigricans on physical exam (unfortunately commonly seen in my practice in adults as well as in teens!), abnormal lab values like elevated uric acid, GGT, high TG/HDL ratio, elevated blood glucose, low testosterone, low vitamin D.

A word on blood glucose. I feel it is very important to make use of the 2 hour glucose tolerance test (fasting, 1 hour and 2 hour post 70 gram carbohydrate challenge). Based on this article in Diabetes care last March (http://care.diabetesjournals.org/content/33/3/557.full), a lot of information can be obtained and education points for patients. The scary realization from the study is that if the 1 hour blood glucose is over 150 mg/dl, you have a 13 times increased risk of becoming diabetic in the next 8 years (even with normal fasting and 2 hour blood glucose)! Worse yet, the risk starts to increase with the 1 hour sugar staring at 120 mg/dl!

So be on the look out and be vigilant, you never know when insulin resistance can rear it's ugly head. Unfortunately, these days it is more common than not.

Eating A Rainbow Counts!

2011-01-25T19:50:00.000-08:00

We always encourage patients to focus on vegetables and fruits (in that order). The main message is variety, especially when looking at colors. We know these natural forms of nutrients and anti-oxidants (as opposed to pills, powders, and magic potions) play an important role in preventing illness and disease.

When you are looking at fruits, try to pick fruits that have skin (ie fiber) like hard apples/pears and any type of berry. Try avoiding fruits that are higher in glycemic index such as melons and pineapple (this means the sugars in these fruits get into the body very quickly causing higher levels of blood glucose).

With veggies, avoid the starchy ones like potatoes, corn, and peas. Target the green leafy veggies like spinach, collards, and kale. Then add the colors like yellow or red bell peppers. Mushroom and onions are good to go as well. Going to a local farmers market can also help in trying variety as you will usually find the in season produce.

Here is a link to one I attend regularly:

http://www.arizonafarmersmarkets.com/pageAhwatukee/ahwatukee.htm

A new study has shown eating veggies and fruits with a variety of color can help prevent hypertension (high blood pressure).

Please click on the article below:

http://www.theheart.org/article/1174585.do

Welcome!

2011-01-25T19:32:00.000-08:00

My name is Rakesh Patel. I am a Family Physician in Gilbert, Arizona. Welcome to my blog. My main goal in treating patients is helping prevent heart attacks and strokes. We look at many risk factors to determine the best path for prevention. I hope you find my posts intriguing and insightful on your road to prevention!