How we eat affects our health

How we eat affects our health

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  How our eatingaffects our health ASPEC / March 8, 2021 / Robert Miller MD
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  “The only wayto keep your health is to eat what you don't want, drink what you don't like, and do what you'd rather not.” Mark Twain
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  “The second dayof a diet is always easier than the first. By the second day you're off it.” Jackie Gleason
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  Obesity Worsens Outcomesfrom COVID-19 Adults with excess weight are at even greater risk during the COVID-19 pandemic: •risk of severe illness • triple the risk of hospitalization •Obesity is linked to impaired immune function. •Obesity decreases lung capacity and reserve and can make ventilation more difficult. •As BMI increases, the risk of death from COVID-19 increases. •Obesity may be linked to lower vaccine responses for numerous diseases (influenza, Hepatitis B, tetanus). https://www.cdc.gov/obesity/data/obesity-and-covid-19.html
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  https://www.medrxiv.org/content/10.1101/2021.02.24.21251664v1.full.pdf
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  How well didwe do to avoid obesity during the pandemic and social isolation?
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  The Impact ofCOVID-19 Stay-At-Home Orders on Health Behaviors in Adults Obesity 2021 Feb;29(2):438-445 7,753 participants were included; 32.2% of the sample were individuals with normal weight, 32.1% had overweight, and 34.0% had obesity. Weight gain was reported in 27.5% of the total sample compared with 33.4% in participants with obesity. People who gained weight also had the largest declines in physical activity. There were some bright spots in the findings. About 17 percent of the study population actually lost weight during the pandemic; perhaps not surprisingly, they tended to be people who increased their physical activity
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  Exercise is alsoa big part of maintaining good health and has to be included into our behavior but our poor eating habits is a bigger issue and will be the main point of this presentation. My favorite expert on health and exercise is Daniel Lieberman, paleoanthropologist at Harvard University, where he is the Edwin M Lerner II Professor of Biological Sciences, and Professor in the Department of Human Evolutionary Biology.
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  The COVID 19pandemic was a reminder of the risks associated with our poor eating habits in the US. 1.The continuing rise of obesity and health risks. 2.The real culprit is insulin resistance then metabolic syndrome 3.Increasing popularity of intermittent fasting A. Is it a logical and safe way to lose excess fat? B. Are there multiple other systemic health benefits from fasting? C. Will fasting increase life expectancy?
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  Important things youmay not know 1. Sugar (esp. fructose) is very toxic and the combination of bad science (eat less fat and eat more carbohydrates) coupled with the profit motive of the food industry created a public health disaster with obesity and type 2 diabetes. (mechanism is insulin resistance and metabolic syndrome Robert Lustig. 2. Continuous stimulation of insulin will prevent access to body fat stores, People who are told to eat frequent small meals throughout the day will almost never have sustainable weight loss (Jason Fung). 3. Good long-term health requires alternating fed states with fasting states (Mark Mattson) and this may also increase longevity. (David Sinclair , Valter Longo). Holding off on microbiome issues at this time
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  Are we getting fatter? 71.6%of American adults are overweight, and 40% are obese
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  Even rich andfamous people can get fat! Marlon Brando Elvis Presley
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  US Government recommendseat more carbs
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  https://www.cdc.gov/nchs/data/hestat/obesity-adult-17- 18/obesity-adult.htm Men Men Women
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  Prevalence of Obesityand Severe Obesity Among Adults: United States, 2017–2018 NCHS Data Brief No. 360, February 2020 https://www.cdc.gov/nchs/products/databriefs/db360.htm
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  Prevalence† of Self-ReportedObesity Among U.S. Adults by State and Territory, BRFSS, 2019 https://www.cdc.gov/obesity/data/prevalence-maps.html
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  https://www.cdc.gov/
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  https://www.cdc.gov/nutrition/strategies- guidelines/index.html
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  https://www.myplate.gov/tip-sheet/healthy-eating-older-adults
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  Obesity is acomplex disorder involving an excessive amount of body fat. Body Mass Index: BMI 25-30 (overweight) BMI >30 (obese)
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  BMI (Body MassIndex) body mass divided by the square of their height, units are Kg/M2 http://www.cdc.gov/healthyweight/assessing/index.html
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  BMI is lessthan 18.5 = "underweight" BMI is 18.5 to 24.9 = "normal" or Healthy Weight range. BMI is 25.0 to 29.9 = "overweight" range. BMI is 30.0 or higher = "obese" range.
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  Body Mass Index Tablesfrom the NIH, with “normal” or healthy should be 18.5 to 24.9
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  So you’re Fat…What’sthe Harm? …Uh…OK other than COVID 19?
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  Obesity raises therisk of morbidity from: - hypertension - dyslipidemia - type 2 diabetes mellitus (diabetes) - coronary heart disease (CHD), - stroke, - gallbladder disease, - osteoarthritis, - sleep apnea and respiratory problems - some cancers. Obesity is also associated with increased risk in all-cause and cardiovascular disease (CVD) mortality.
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  NCI – many cancershave been linked to overweight or obesity
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  All-cause mortality versusBMI Normal 18.5 to 25 Male Female Body-mass index and cause- specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet 2009;373:1083
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  All-cause mortality versusBMI White Women Body-Mass Index and Mortality among 1.46 Million White Adults NEJM 2010:363:2211
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  White Men All-cause mortalityversus BMI
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  The Obesity Paradox? Associationof All-Cause Mortality With Overweight and Obesity Using Standard Body Mass Index Categories. A Systematic Review and Meta-analysis Katherine M. Flegal, PhD / JAMA. 2013;309(1):71-82 BMI Description HR For All Cause Mortality 18.5 – 24.9 Normal 1.00 25 – 29.9 Overweight 0.94 30-34.9 Grade 1 Obesity 0.95 >35 Grade 2,3 Obesity 1.29 Grade 1 obesity overall was not associated with higher mortality, and overweight was associated with significantly lower all-cause mortality. Not so bad
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  BMI and all-causemortality in older adults: a meta-analysis Am J Clin Nutr 2014 Apr;99(4):875-90 meta-analysis came out in 2014 by Winters et al. looking at BMI and all-cause mortality in adults over age 65 and BMI ranges and the risk of death by any cause meta-analysis looked at 32 different studies and included 197,940 older adults (ages 65+) with an average follow-up of 12 years. In Seniors a higher BMI in the range of 27 may be best
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  https://www.thegeriatricdietitian.com/bmi-in-the-elderly/ Sarcopenia (muscle massloss) may be more dangerous than obesity, wo if weight loss is desired patient should take adequate protein and resistance training Consider this higher range normal
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  Sarcopenia is asyndrome characterized by the loss of muscle mass, strength, and performance. Sarcopenia was identified in 53 to 57 percent of men, and 43 to 60 percent of women, over the age of 80 in one study Inactivity exacerbates ongoing muscle loss and increases proportion of body fat mass Inadequate protein intake can also contribute to sarcopenia and decreased function. A prospective cohort study found that adults aged 70 to 79 with protein intake ≤0.8 g/kg/day (the Recommended Dietary Allowance [RDA]) were at greater risk of developing mobility limitations mean upper arm circumference (MUAC) MUAC measures the circumference of the left upper arm at the mid-point between the tip of the shoulder and the tip of the elbow MUAC of less than 22 cm for women and 23 cm for men are suggestive of
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  A SYSTEMATIC REVIEWOF THE LITERATURE CONCERNING THE RELATIONSHIP BETWEEN OBESITY AND MORTALITY IN THE ELDERLY. J Nutr Health Aging. 2012 Jan; 16(1): 89–98. Mortality Rate per 100,000 Seniors may be healthier at higher weights than standard BMI Tables
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  ‘Normal’ weight forSeniors From Up to Date
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  Important things youmay not know Sugar (esp. fructose) is very toxic and the combination of bad science (eat less fat and eat more carbohydrates) coupled with the profit motive of the food industry created a public health disaster with obesity and type 2 diabetes. Mechanism is Non-alcoholic fatty liver disease is the cause of insulin resistance and metabolic syndrome Recommendation: avoid sugar and refined carbohydrates Robert Lustig
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  Robert Lustig -What is Metabolic Syndrome Anyway? https://youtu.be/zx-QrilOoSM Prof. Robert Lustig - 'Sugar, metabolic syndrome, and cancer’ https://www.youtube.com/watch?v=jpNU72dny2s&ab_cha nnel=LowCarbDownUnder Fructose 2.0 | Robert Lustig Website https://robertlustig.com/fructose2/ Is a Calorie a Calorie? Processed Food, Experiment Gone Wrong https://www.youtube.com/watch?v=nxyxcTZccsE&ab_channel=StanfordHealthCare Robert Lustig MD, Pediatric Endocrinologist at UCSF
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  Not fat here Visceralfat here
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  Non-alcoholic fatty liverdisease is the cause of insulin resistance and metabolic syndrome
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  Evidence Summary Weight Lossto Prevent Obesity-Related Morbidity and Mortality in Adults: Behavioral Interventions September 18, 2018 A total of 122 RCTs (N = 62,533) and 2 observational studies (N = 209,993) were identified. Compared with controls, participants in behavior-based interventions had greater mean weight loss at 12 to 18 months (−2.39 kg) and less weight regain (−1.59 kg) Participants with prediabetes in weight loss interventions had a lower risk of developing diabetes compared with controls (relative risk, 0.67. There was no evidence of other benefits, No evidence of harm such as cardiovascular disease from behavior-based interventions; higher rates of adverse events were associated with higher dropout ‘Evidence’ Based Guidelines
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  Important things youmay not know Continuous stimulation of insulin will prevent access to body fat stores, People who are told to eat frequent small meals throughout the day will almost never have sustainable weight loss (Jason Fung) Recommendation: Consider Fasting
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  Dr. Jason Fung,MD Dr Jason Fung is a doctor, author and researcher. His science-based books about diabetes and obesity, The Diabetes Code, The Obesity Code and The Complete Guide to Fasting have sold hundreds of thousands of copies. Dr Fung is also the co-founder of the Intensive Dietary Management Program, to help people lose weight and reverse Type 2 Diabetes naturally with fasting. His work on fasting has been cited by the Daily Mail, Telegraph, CNN, TIME, the Atlantic, Forbes and many other media outlets.
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  “I fast forgreater mental and physical efficiency” Plato "Fasting is the greatest remedy-- the physician within.“ Philippus Paracelsus, one of the three fathers of Western medicine "The best of all medicines is resting and fasting." Benjamin Franklin
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  Traditional way of thinking about weightloss diet, reduce calories and increase exercise When the patients fails to have sustainable weight loss, ‘blame’ the patient
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  Why Conventional DietsFail 1. Every time you eat (esp with carbs and sugar) your pancreas see the rise in glucose and produces insulin 2. Insulin lowers your sugar (so you get hungry in a few hours) and prevents lipolysis (won’t let you release fat storage for energy) 3. If you just reduce calorie input but still eat frequent small meals your body sees the calorie reduction and tries to ‘help’ by lowering metabolism (to reduce energy consumption) and raising ghrelin (hunger hormone to motivate you to search for food) 4. If you fast (at least 12 hours a day) once your body has consumed blood glucose and then stored glycogen (4 – 12 hours) then the pancreas secretes glucagon and you release fat storage, you have more energy and you suppress hunger (once it has access to all the energy in fat storage you no longer feel starvation)
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  Typical results from large long- term studies utilizing reduced calorie intakewith increase exercise Women’s Health Initiative Trial, JAMA 2006:295:39 Change in weight over 9 Years
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  Conventional Diet willbe Resisted by the Body Set Weight 1. Reduce body energy expenditure 2. Increase your hunger Long-Term Weight Loss 1. Keep Basal Metabolic Rate (BMR) Stable 2. Stop hunger signaling Control Insulin. Fasting
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  All the other healthbenefits from fasting Jason Fung Eat during a 6 to 8 hour window
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  Besides losing weight (unwantedfat not lean body mass or muscle) there are other significant health benefits from fasting
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  Important things youmay not know Good long-term health requires alternating fed states with fasting states (Mark Mattson) and may also increase longevity. (David Sinclair).
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  Mark P. Mattsonis a Professor of Neuroscience at Johns Hopkins University.He is the former Chief of the Laboratory of Neurosciences at the National Institute on Aging Intramural Research Program of the National Institute on Aging. Mattson has done research on intermittent fasting. The National Institute of Health considers him "one of the world’s top experts on the potential cognitive and physical health benefits of intermittent fasting
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  Hormesis Low levels of stressare good for you. What doesn’t kill you makes you stronger. Friedrich Nietzsche
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  Exercise, fasting, neurostimulation will increase glutamateand BDNF (brain derived neurotrophic factor in hippocampus also causing stem cells to form new nerve cells
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  Professor in theDepartment of Genetics and co-Director of the Paul F. Glenn Center for the Biology of Aging at Harvard Medical School. He is best known for his work on understanding why we age and how to slow its effects. He obtained his Ph.D. in Molecular Genetics at the University of New South Wales, Sydney in 1995. He worked as a postdoctoral researcher at M.I.T. with Dr. Leonard Guarente where he co discovered a cause of aging for yeast as well as the role of Sir2 in epigenetic changes driven by genome instability.
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  Three main defensesystems you need to turn on for prolonged health (to live longer) genes are hormesis sensers and will respond to stress by turning on a protecting you mTOR – senses protein (avoid too much meat) AMPK – take Metformin and also responds to hunger Sirtuins need NAD energy / you can use raise NAD by exercise or fasting (being hungry) or molecules like NMN or Resveratrol
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  David Sinclair
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  Valter D. Longo isan biogerontologist and cell biologist known for his studies on the role of fasting and nutrient response genes on cellular protection aging and diseases and for proposing that longevity is regulated by similar genes and mechanisms in many eukaryotes He is currently a professor at the USC Davis School of Gerontology with a joint appointment in the department of Biological Sciences as well as serving as the director of the USC Longevity Institute
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  Longevity Diet for Adults 1.Eatmostly vegan, plus a little fish, limiting meals with fish to a maximum of two or three per week.. 2.Over age 65, you should slightly increase protein intake but also increase consumption of fish, eggs, white meat, and products derived from goats and sheep to preserve muscle mass. Consume beans, chickpeas, green peas, and other legumes as your main source of protein. 3.Minimize saturated fats from animal and vegetable sources (meat, cheese) and sugar, and maximize good fats and complex carbs. Eat whole grains and high quantities of vegetables (tomatoes, broccoli, carrots, legumes, etc.) with generous amounts of olive oil (3 tablespoons per day) and nuts (1 ounce per day). 4.Follow a diet with high vitamin and mineral content, supplemented with a multivitamin buffer every three days. 5.Select ingredients among those discussed in this book that your ancestors would have eaten. 6.If you are overweight or tend to gain weight easily, consume two meals a day: breakfast and either lunch or dinner, plus two low-sugar (less than 5 grams) snacks with fewer than 100 calories each. If you are already at a normal weight, or if you tend to lose weight easily or are over 65 and of normal weight, eat three meals a day and one low-sugar (less than 3 to 5 grams) snack with fewer than 100 calories. 7.Confine all eating to within a twelve-hour period; for example, start after 8 a.m. and end before 8 p.m. Don’t eat anything within three to four hours of bedtime.
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  Can Seniors DoIntermittent Fasting? 1. Goal is to eat healthy food, avoid sugar and refined carbohydrates and limit eating window to an 8 hour period (or less) 2. Stop eating by 6 pm then at 6am already have completed a 12 hour fast, wait till 10am (16 hours) and if you can wait till noon (18 hours) 3. Drink lots of black coffee (green tea would probably be better) till noon 4. Exercise in the morning (power walks at 6am / 5.5mi / 15-16 min per mile) 5 days a week plus barbells for 20 minutes 4 times a week 5. Lunch – oatmeal or fiber one or yogurt with fruit (raspberries/ blackberries) plus an apple or a hard-boiled egg 6. Dinner at 4 to 5:30 – huge salad or healthy meat (chicken or fish) or even Healthy Choice plus vegetables 7. Occasional alcohol , red wine would be best but lite beer or Scotch 178 pounds 128 pounds BMI 28.7 BMI 20.7 All the junk food you miss (breads and deserts) only occasionally
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  Evolutionary biology and evolutionarypsychology Hunger signal: “I must eat”! Can you train yourself to respond differently? “Great, the signal tells me I’m now switching over to stored fat as fuel and allowing my body to restore itself.” Do you eat to live… or live to eat?
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  Along with makingsmarter food choices should you consider timing … Advice as of March 2021 Shelf life of any medical advice is getting shorter and shorter with the pace of new information flooding in Pretty solid evidence that our health requires regular stressors in moderation for optimal health and longevity. To allow the body and brain to properly maintain itself we should alternate between fed states and fasting states and most people could probably go 12 hours between each If someone has been unsuccessful with losing excessive body fat, they may want to reduce the feeding interval down to 6 or 8 hours on most days but should consult with their own physician and review the best advice (Jason Fung)
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  75% of weightis genetic