These statistics are based on BMI; a notoriously inaccurate measure of body composition.  After all, it isn’t really weight that people want to lose, it is body fat.  We have just become accustomed to equating excess weight with excess fat.  But the two can be radically different.  BMI does not adequately take lean muscle mass into account and routinely underestimates the body fat percentage of individuals.  And it is excess body fat, particularly the deep visceral belly fat that is associated with an increased risk of diabetes, cardiovascular disease, high blood pressure, metabolic syndrome, breast cancer, colorectal cancer, gallbladder issues, dementia and more.  As if that was not enough, preliminary research from Boston University researchers has found a “significant” link between visceral fat and lower total brain volume[4].

The research looked at 733 healthy individuals that were part of the Framingham Offspring cohort with an average age of 60.  Seventy percent of the participants were women.  Researchers looked at the potential associations of body mass index (BMI), waist circumference, waist-to-hip ratio, and abdominal fat with the total brain volume.  Abdominal fat was measured by CT scan and could differentiate the deep visceral fat from the subcutaneous fat just under the skin surface.  While there was an association with BMI and waist circumference, the real culprit was visceral fat.  Subcutaneous fat was not [significantly] associated with any adverse effect on the brain volume, whereas visceral fat was clearly associated with smaller brain volume.  Smaller brain volume is associated with poor cognitive function on testing and a greater risk of dementia on follow-up.

 What can you do to reduce your body fat? 

•  Make the decision to make a change.  Resolutions won’t cut it.  The vast majority only last a couple of months, at best.  This change is for your lifetime.
• Exercise regularly.  You need to do both strength/resistance and aerobic activity.  Interval training is the best and most effective method of combining both.
• Low Glycemic nutrition.  Balance is key:  adequate protein, healthy fats and fewer carbohydrates.  Excess sugars and processed carbohydrates are the real enemies.  Not dietary fats.  Avoid man made trans-fats but you need to eat healthy fats in order to lose body fat. 
• Eat smaller frequent meals throughout the day of natural, nutrient-dense whole foods
• Hormonal assessment.  Check your hormone levels to determine options for balancing your endocrine system.

 The key message is pretty clear.  How you take care of yourself now will determine how well you can maintain both your physical and cognitive prowess as you age.  This concept is not new.  Don’t wait until it is too late.  There is no time better than now to start living better.

It is now clear that significant cognitive decline is not an inevitable consequence of advanced age.  Several recent studies have demonstrated an association between eating a Mediterranean-style diet and slower cognitive decline in the elderly.[i]   A well-designed prospective study published last year in the American Journal of Nutrition analyzed data from a continuing study of 3,790 Chicago residents 65 and older that began in 1993. The researchers tested the subjects’ mental acuity at three-year intervals, and tracked their degree of adherence to the Mediterranean diet on a 55-point scale. High scores for adherence to the diet were associated with slower rates of cognitive decline, even after controlling for smoking, education, obesity, and hypertension.

Another study, presented at the American Academy of Neurology’s April 2010 meeting in Toronto, analyzed the diets of 712 New Yorkers.  MRI brain scans taken an average of 6 years later revealed brain infarcts in one third of the study participants.  Brain infarcts are small areas of dead brain tissue caused by silent strokes that may show no symptoms. Recent research has suggested that brain infarcts may be responsible for decreasing cognitive function as we age.  In this study, the group who most closely followed a Mediterranean-style diet was 36% less likely to have the damaging brain infarcts than the group who least followed the diet, and moderate followers were 21% less likely to have damage than the lowest-tier group.  A third study published in the February 2009 issue of Archives of Neurology found that eating a Mediterranean diet was possibly associated with a reduced risk of developing mild cognitive impairment (MCI) and of MCI advancing to Alzheimer’s disease.

Benefits of the Mediterranean diet may be due to the it’s positive impact on cholesterol levels, blood sugar levels, vascular health, or inflammation reduction; all of which have been linked with cognitive impairment. Is this proof positive that the Mediterranean diet can prevent stokes and dementia?  No. Although there is a lot of data suggesting beneficial effects of a Mediterranean diet on a number of chronic medical conditions, diet alone is not the only factor,.  Diet is but one component of a healthy lifestyle, and that includes regular exercise, prevention or treatment of diabetes, hypertension, high cholesterol, obesity—if they exist, and avoidance of smoking gives you your best chance to remain cognitively intact as you age.

What are added sugars? 

Added sugars included table sugar, brown sugar, high-fructose corn syrup (HFCS), honey, molasses, brown rice syrup, agave syrup and other caloric sweeteners in prepared and processed foods — for instance, in soft drinks, iced tea, candy, pastries, cookies and canned fruits.  These added sugars provide no nutritional value.  Some may find it surprising that honey is included here, but honey has 35% more calories per tablespoon than table sugar. 

Extent of the epidemic

Americans now consume over 100 pounds of added sugars per person per year; more than a 50% increase from 30 years ago.  This is equivalent to 22 teaspoons per day!  It is also nearly three times higher than the level found not to “conclusively demonstrate a hazard to the general public.”[1]   So how much of any substance can be consumed before it goes from harmless to toxic?  It is generally accepted that a glass of red wine may have certain health benefits, but we all know the problems that drinking too much can bring.  It is hard not to blame added sugars for the obesity and diabetes epidemics we now face in this country.  In 1980, approximately one in seven Americans was obese and almost 6 million were diabetic.  Thirty years later, coinciding with increased sugar consumption, one in three Americans are obese and more than 14 million are diabetic.

Throughout our history, there has been a suspicious but not incontrovertible association between sugar consumption and disease.  From the late 19^th and early 20^th centuries there was a very notable increase in sugar consumption as the candy and soft-drink industries grew, along with a parallel increase in diabetes incidence and deaths.  

Is it just the calories?

Conventional recommendations from the Department of Agriculture or the American Heart Association[2] advise reducing sugar intake because of the excess empty calories; that is, the lack of any vitamins, minerals, protein, or fiber, that leads to weight gain and related diseases like diabetes.  High-fructose corn syrup has become one of the most vilified food additives but a growing number of nutrition researchers believe that there is little difference between HFCS and refined sugar, at least with respect to how they are metabolized in your body.  The evidence that HFCS consumption uniquely increases the risk of weight gain is very weak.[3]  HFCS is not used extensively outside the US but obesity rates are increasing worldwide.

Refined sugar (sucrose) is made up of two different sugar molecules, glucose and fructose in a 50-50 mixture.  Other carbohydrates, such as bread, potatoes and pasta break down to glucose.  That is, bread that does not contain HFCS.  Glucose is metabolized and used for energy by all cells in your body.  HFCS is 45% glucose and 55% fructose.  There is also fructose that occurs naturally in fruits, but the absorption rate of the sugar is blunted by the fruit’s fiber content.  Anywhere fructose is found in nature, there is always fiber present.  Fructose is metabolized by the liver and when present in sufficient quantities will be converted into fat.  The speed with which fructose arrives in the liver also influences the rate of conversion to fat.  This is a critical point, since soft drinks are by far the biggest culprits for the glut of sugar consumed, and the fastest way to absorb sugar.   In the 1950′s a typical soda contained 10 ounces; now we have 44 ounce Big-Gulps.  The more sugar consumed, the more insulin your body needs to produce to try and manage it.  In the presence of high insulin levels, more of your calories are stored as fat, creating a vicious cycle that ultimately leads to insulin resistance and fat accumulation in the liver.  And, what has become the most common form of liver disease, non-alcoholic fatty liver (NAFLD), has been linked to an increased consumption of fructose.[4]

Another hormone, leptin, is the satiety hormone.  It sends the signal to your brain to stop eating.  Its effects are essentially disabled in people with insulin resistance.  When leptin isn’t being released, or the signals not processed the way it’s supposed to–as happens in insulin-resistance–your brain doesn’t know you’ve already had enough to eat.  It thinks you’re starving, so you just eat more.  You end up in a vicious cycle of consumption and then disease.  In many obese individuals, leptin resistance contributes to thier difficulty in losing weight.

Sugars, lipids and hypertension

A study published last year looked at the relationship of added sugars to blood lipid levels.  Researchers compared the diets and blood profiles of over 6100 adults from the National Health and Nutrition Examination Survey.  Even after controlling for other variables including body mass index (BMI), physical activity, and total energy expenditures, the results showed that participants consuming the least amount of added sugars had higher HDL (good) cholesterol, lower triglycerides and lower LDL (bad) cholesterol.  The researchers concluded that there was an important association between increased sugar consumption and cardiovascular risk factors.  In another recent study, consumption of sugar-sweetened beverages was associated with significantly elevated blood pressure and increased BMI[5]

What does it all mean? 

Obesity, altered blood lipids, hypertension and insulin resistance adds up to metabolic syndrome; one of, if not the major risk factor for heart disease and diabetes.  While it hasn’t been conclusively determined what initially causes metabolic syndrome or what the initial event is in the insulin resistance cascade, there seems to be a remarkably strong correlation between liver fat and insulin resistance.[6]   Insulin resistance, obesity and metabolic syndrome are also closely associated with an increased risk of cancer.[7] 

If sugar consumption leads to insulin resistance, and insulin resistance is one of the fundamental underlying defects in cancer, as it is in type-2 diabetes and heart disease, then it seems to follow that excessive sugar consumption may cause cancer.  Even if the final scientific conclusions are not in, isn’t the association enough to make you rethink how much sugar you are willing to consume?

In 2010, nearly 1.6 million newly diagnosed cancer cases and more than 500,000 cancer deaths were expected in the US.  Cancer is the second leading cause of death in the US, exceeded only by cardiovascular disease.  Approximately 1 in every 4 deaths is attributable to cancer.[1]  But nearly 340,000 cancer cases in the United States could be prevented each year by adopting a healthier lifestyle, according to the World Cancer Research Fund (WCRF)[2].  In addition, a third of cancers can be cured through early detection and treatment. 

What is it about a healthier lifestyle that can help prevent cancer?  New research has uncovered an association between telomere length and cancer risk.  People who have white blood cells (leukocytes) with shorter telomeres may be at a higher risk of developing cancer, especially aggressive cancers that are more likely to kill.  Telomeres are the “shoelace ends” that cap and protect your chromosomes and naturally get shorter as you age.  Researchers measured leukocyte telomere length in 787 individuals who did not have cancer then followed them for ten years.[3]   Those with the shortest telomere length had more than triple the risk of developing cancer, and those in the middle group had twice the risk compared to those with the longest telomere length.  Those in the short telomere group also had a higher risk of dying from their malignancy than those with longer telomeres.

There is a mounting body of evidence linking short telomeres to a higher risk for a variety of cancers.  Studies have found shortened telomeres in breast cancer cells[4], bladder cancer cells[5], oral cavity cells[6] and colon cancer cells[7].  An Italian study found that individuals with the longest telomeres were ten times less likely to develop cancer than those with shorter telomeres.[8]

How does that fit in with a healthy lifestyle?  Following a Mediterranean diet can significantly reduce cancer risk.  A study published last year showed that by eating five servings of fruits and vegetables you could reduce your cancer risk by 6-11%.[9]   Eating a plant based diet has been shown to increase the activity of telomerase, the enzyme that repairs and rebuilds telomeres by 30%, resulting in improved telomere maintenance.[10]  

Regular vigorous exercise also activates the telomerase enzyme.[11]  Not surprisingly, exercise has been shown to reduce cancer risk and cancer mortality in men and women.

Women who engaged in more than 7 hours per week of moderate-to-vigorous exercise for the last 10 years were 16% less likely to develop breast cancer than those who were inactive.[12] And vigorous exercise for 20 minutes per day, 5 day per week significantly reduced the risk of fatal prostate cancer in men[13]

Obesity carries an enhanced risk for numerous cancers and obese adults have shorter telomeres than their normal-weight counterparts.[14]  We have known for decades that smoking increases your risk for cancer.  We now know that smoking accelerates telomere shortening.[15]  In fact, obesity and smoking are states of heightened oxidative stress, which increases the rate of telomere erosion per replication, and increases inflammation.[16]

Besides exercising, eating better and maintaining a healthy body weight, vitamin supplements offer additional protection for your telomeres. Daily intake of vitamin D in the 4000 – 8000 IU range was associated with a substantial reduction in the risk for breast cancer, colon cancer, multiple sclerosis and diabetes.[17]  Higher blood levels of vitamin D are associated with longer telomeres.[18]  Resveratrol[19] and just taking a multivitamin resulted in longer telomeres in women.[20]

You have the power to alter your biological aging clock by the choices you make in how you eat and live.  The same choices will lower your risk of most chronic diseases, including cancer.  Isn’t this what we call a “no-brainer”?  

Two high profile stroke victims highlight this trend among younger people.  Delaware attorney general Beau Biden suffered a stroke at age 41 last year.  His was classified as “mild” and he has made a good recovery.  Typically younger people recover better as they have retained more brain plasticity and have fewer co-morbidities to complicate their recovery.

 Less fortunate was rapper Nate Dogg who died this week from congested heart failure and complications from previous strokes.   He was only 41, but according to the LA Times and USA Today, he suffered from two previous strokes; the first at age 38 and the second the following year.  I certainly do not know all the details of his condition, but having a stroke puts you at significantly increased risk of having subsequent strokes.  It should be a wake-up call.

 How can you prevent a stroke?  Although there are several risk factors that you cannot change, such as family history, being African American or male[1], there are a number of risk factors that are modifiable.  A large case-control study evaluating the risk factors for stroke ahs identified 10 modifiable risk factors that are associated with 90% of stroke risk.  Of those modifiable risk factors, hypertension was the most important for all stroke types.[2]  In that study a history of hypertension was associated with a more than 2.5-fold increase in the risk for stroke.  The other risk factors included smoking, abdominal obesity, lack of regular physical exercise, diabetes, diet and alcohol intake, abnormal lipid profile, stress and depression.

 Not coincidentally, the risk factors for stroke and heart disease are the same; the relative importance of each risk factor varies for each disease.  And, the same lifestyle modifications that could reduce your risk of both heart disease and stroke also reduce your risk of diabetes and being obese, which further reduces your risk of having a vascular event.  It all boils down to modifying your lifestyle to avoid these debilitating chronic diseases, improve your quality of life and reduce your chance of dying prematurely.

 The word “mojo” has origins in African language and refers to magic or voodoo to generate luck and power. In the early 20^th century, it still referred to a source of vigor, energy, sexual potency and power, particularly for men. More recently, it has been expanded to mean power or influence of any kind.  An entire Austin Powers movie was devoted to his lost mojo and his desperate search to find it. He ultimately discovers his mojo is within, and that he had access to it all along.

 As we age, our capacity for physical exertion, as measured by maximal oxygen consumption, declines 10-15% per decade after age 20.  This is primarily due to relative physical inactivity and accumulation of body fat.   And, the average American gains 1 lb of fat every year between ages 30 to 60, and loses ½ lb of muscle.  This age-related deterioration in muscle mass, muscular strength and aerobic fitness correlates with the loss of independence in later life.  What can be done to recapture the feeling of your youth?  It’s simple; nothing that we do for ourselves to attain and maintain optimal health is more important than regular vigorous exercise. 

 Improving cardiorespiratory fitness is associated with lower risk of heart attack, stroke, and premature death.[1]  Resistance exercise retards the insidious age-related loss of muscle mass and strength that can lead to frailty.  Exercise helps you stand taller, feel more confident, sleep better, manage stress more effectively, manage your weight and boost libido. Walking speed has been correlated with survival among older adults.[2]

 Exercise has been called the closest thing we have to a fountain of youth.  It turns out that at the cellular level, exercise improves telomere maintenance by increasing the activity of the enzyme telomerase that builds and repairs telomeres.[3]  Telomeres are the part of your chromosomes that control aging.  They represent your biological clock.  When you are young your telomeres are longer and progressively shorten with age.  But the rate at which that shortening occurs is directly influenced by lifestyle choices.  So at any age, healthier individuals have longer telomeres than their unhealthy counterparts. There is also another way that exercise improves your health and keeps you young, and it has to do with something called mitochondria.  The latest evidence demonstrates that telomere dysfunction (shortening) impairs the production and function of mitochondria.[4] 

 Mitochondria are the power plants where fuel is burned, energy is produced and harmful free radicals are neutralized.  The number of mitochondria that you have in your cells determines your performance capacity.  But that number is not fixed.  While the process of synthesizing new mitochondria is complex, there are several pathways that have just recently been described.  The best known and most effective way to produce more mitochondria is with exercise.[5]  

 Mitochondrial production increases in direct proportion to the amount of physical activity performed.[6] [7] It is controlled by stimulating the master regulator of mitochondrial biogenesis known as PCG-1 alpha.  In addition to directly increasing the activity of PGC-1 alpha, exercise also stimulates the production of three intermediary factors.  Each of those intermediaries also directly stimulates the production of mitochondria, and they can be stimulated by nutritional interventions.  

 Resveratrol, a compound found in red wine, has been associated with anti-cancer activity, cardioprotective activity, antioxidant and anti-inflammatory activity, anti-viral activity and anti-neurodegenerative activity.[8] [9] [10]  Resveratrol, in addition to PGC-1 alpha, activates a class of genes called sirtuins that improve the efficiency of metabolism, reduce cellular stress and promote cellular survival.  It also results in increased production of nitric oxide (NO).

 Nitric oxide is produced by a layer of cells lining blood vessel walls and regulates the flow of blood to tissues.  When released, it causes the blood vessels to relax and expand, increasing blood flow and oxygen to tissues.  NO is necessary for a man to achieve an erection and is the pathway affected by medications like Viagra.  NO has recently been found to directly regulate the oxygen supply to mitochondria.[11]  NO is produced from the amino acid, L-arginine.  There are a number of animal and human studies documenting the beneficial effects following L-arginine supplementation.[12]  Those benefits are attributed to the increase in NO production.  The effectiveness of L-arginine can be enhanced by the addition of alpha-ketoglutaric acid (AKG).  AKG is more bioavailable. It’s faster acting and extends NO production, giving you a longer-lasting effect.

 Alpha Lipoic Acid (ALA) increases energy expenditures, improves insulin sensitivity, and reduces appetite.[13]  It functions by activating an enzyme (AMPK) that regulates cellular metabolism.  AMPK is the “fuel sensor” enzyme for the body and is the pathway through which ALA increases mitochondrial biogenesis.  A controlled release version has been tested and found to be safe in diabetics, and significantly improved measures of glucose control.[14]

 What’s the bottom line?  We all know, or at least have heard that exercise is good for your health.  Here you have a pretty detailed road map to the underlying cellular mechanisms that demonstrate what exercise does for your body.   Additionally, you see that directed nutritional interventions can activate one or more of the same pathways as exercise leading to the same beneficial effects.  Does that not mean that you should forgo exercise in favor of just taking those supplements?  No. The nutritional cocktail described should be taken in conjunction with a regular exercise program.  It is an adjunct to maximize the production of mitochondria and increase energy reserves.  

 Why should you bother?  More efficient energy production, increased exercise performance, reduced body fat, improves sexual performance, reduced inflammation and oxidative stress, and a lowered risk of developing one of the chronic diseases associated with aging.  The potential payback is huge and will impact every aspect of your health and well being.  You’ll look better, feel better and enjoy life more.  You may even get back your swagger.  So what are you waiting for?

[2] Studenski S, et al. Gait Speed and Survival in older adults. JAMA 2011; 303: 50-58

[3] Physical Exercise Prevents Cellular Senescence in Circulating Leukocytes and in the Vessel Wall.  Circulation 2009 Nov 30.

[4] Sahin E, Colla S, Liesa M, et al. Telomere Dysfunction Induces Metabolic and Mitochondrial Compromise. Nature. Feb 2011; 470: 359-65

[5] Reznick RM, Shulman G. The role of AMP-activated protein kinase in mitochondrial biogenesis. J Physiol 2006; 574:33-39

[6] Baar K, Wende AR, Jones T, et al. Adaptations os skeletal muscle to exercise: rapid increase in transcriptional coactivator PGC-1. FASEB J 2002; 16:1879-86

[7] Coffey VG, Hawley JA. The molecular basis of training adaptation. Sports Med 2007; 37:737-763

[8] Baur J, Sinclair D. Therapeutic potential of resveratrol: the in vivo evidence. Nat Rev Drug Discov 2006; 5:493-506

[9] Harikumar K, Aggarwal B. Resveratrol: A multitargeted agent for age-associated chronic diseases. Cell Cycle 2008; 7:1-18

[10] Orallo F. Trans-resveratrol: a magical elixir of eternal youth? Curr Med Chem 2008; 15:1887-98

[11] Clementi E, Nisoli E. Nitric oxide and mitochondrial biogenesis: a key to ong term regulation of cellular metabolism. Comp Biochem Physiol A Mol Integra Physiol 2005; 142:102-110

[12] Preli R, Klein K, Herrington D. Vascular effects of dietary L-arginine supplementation. Atherosclerosis 2002; 162:1-15

[13] Xue B, Khan B. AMPK integrates nutrient and hormonal signals to regulate food intake and energy balance through effects in the hypothalamus and peripheral tissues. J Physiol 2006; 574:73-83

[14] Evans JL, Heyman CJ, et al. Pharmacokinetics, tolerability and fructosamine-lowering effect of a novel, controlled-release formulation of alpha lipoic acid. Endocr Pract 2002; 8:29-35

Many health and nutrition experts have long recommended limiting dietary saturated fats and avoiding full fat dairy products.  Marion Franz, a registered dietitian with the American Diabetes Association nutrition task force was quoted as saying, “the link between eating saturated fats and heart disease is well established.” Yet a recent meta-analysis failed to show any increased risk of coronary heart disease or cardiovascular disease from saturated fats.[1]  Trans fats found in hydrogenated oils are industrially produced and have been associated with higher risks from heart disease.   In contrast, researchers found that adults with the highest levels of trans-palmitoleic acid in their blood had a three-fold lower risk of developing diabetes.  Interestingly, those individuals also had lower body fat, higher good cholesterol levels, and lower triglyceride levels, which are all associated with better cardiovascular well outcomes.[2]   Trans-palmitoleic acid is a naturally occurring fatty acid found in milk, cheese, yogurt, butter and meat.

This study examined 3,736 participants in the National Heart, Lung, and Blood Institute-funded Cardiovascular Health Study, who have been followed for 20 years in an observational study to evaluate risk factors for cardiovascular diseases in older adults.  “It’s exciting because traditionally fats were just seen as artery cloggers, but they seem to be both harmful and protective,” said lead author and Harvard epidemiologist Dariush Mozaffarian. “The fatty acid world is becoming more interesting and complex.”

There are a number of problems with the current low-fat recommendations.  It has created an environment where people avoid all fats indiscriminately, when many are healthy and beneficial.  In fact, in order to burn fat you need to eat fat.  Another major problem has been the substitution of refined carbohydrates for the fats.   It is abundantly clear that excess highly processed carbohydrates leads to insulin resistance and the accumulation of excess body fat (see “Low Fat vs Low Carb”). 

Being overweight or obese is far more than just carrying around excess weight or wearing bigger clothes.  It is a well-established risk factor for diabetes, heart disease, hypertension, elevated cholesterol, stroke, metabolic syndrome, arthritis, several cancers and premature death.

We all know that adopting a healthier lifestyle can significantly reduce the epidemics of obesity and type 2 diabetes.  The same healthy lifestyle modifications can lower your risk of heart disease and certain cancers.  Should we all start drinking more milk?  No, these finding are still preliminary.  There have been several studies that suggest dairy lovers have a lower diabetes risk, but there are also many studies linking the same benefit to the Mediterranean diet — typically low in dairy, but high in fats from olive oil and fish, and rich in high-fiber grains, vegetables and legumes.  A separate meta-analysis of 17 prospective studies looking at the association between dairy consumption and cardiovascular disease concluded that milk consumption was not harmful but did not demonstrate any significant cardiovascular risk reduction.[3]

So for the meantime, it is best to maintain a healthy weight by exercising regularly and following a diet lower in refined carbohydrates, higher in protein and healthy fats than the typical American diet.  But if you enjoy milk, there is no reason to avoid it because of its fat content.

[2]  Mozaffarian D, Cao H, King I, Lemaitre R, Song X, Siscovick D, Hotamisligil G, ‘Trans-Palmitoleic Acid, Metabolic Risk Factors, and New-Onset Diabetes in U.S. Adults: A Cohort Study’, Ann Intern Med December 21, 2010 153:790-799

[3] Soedamah-Muthu SS, Ding EL, Al-Delaimy WK, et al. Milk and dairy consumption and incidence of cardiovascular diseases and all-cause mortality: dose-response meta-analysis of prospective cohort studies. Am J Clin Nutr 2010; DOI: 10.3945/acjn.2010.29866.

Despite its benefits, far too many Americans are chronically sleep deprived.  We live in very stressful times.  One-third of Americans are losing sleep over the state of the U.S. economy and other personal financial concerns.[1]  According to the National Sleep Foundation, 20 percent of us get less than 6 hours sleep a night.  For many others, a good night’s sleep is increasingly losing out to the distractions and extremely hectic nature of our modern life. Some hard-charging professionals even shun regular sleep in deference to the philosophy “I’ll sleep when I am dead”.  Well it turns out that getting enough sleep, and other kinds of rest, just might postpone when your death occurs as well as increase the effectiveness and joyfulness of your life.

One way to think about the function of sleep is to compare it to another of our life-sustaining activities: eating. Hunger is a protective mechanism that has evolved to ensure that we consume the nutrients our bodies require to grow, repair tissues, and function properly.  Both eating and sleeping are regulated by powerful internal drives. Going without food produces the uncomfortable sensation of hunger, while going without sleep makes us feel overwhelmingly sleepy. And just as eating relieves hunger and ensures that we obtain the nutrients we need; sleeping relieves sleepiness and ensures that we obtain the sleep we need.

 Insufficient sleep may alter crucial hormone functions and energy expenditures.  A recent study found that a restriction in the amount of sleep time compromised the effectiveness of a reduced calorie diet for weight loss and reduction of metabolic risk factors.[2]  Another study found that sleep deprivation was associated with a two-fold risk of being obese in children and adults.  That research also suggested that those who slept less have a greater increase in body mass index and waist circumference over time and a greater chance of becoming obese over time.[3]  Obesity has, in turn, been linked to a variety of chronic and life-threatening diseases, including sleep apnea; a common disorder in which the upper airway is intermittently narrowed or blocked, disrupting sleep and breathing during sleep.  Researchers from the Sleep Heart Health Study found that sleep apnea doubled the risk for strokes in men, and increased the danger for women.[4]

 Physiologic studies suggest that a sleep deficit may put the body into a state of high alert, increasing the production of stress hormones and driving up blood pressure, a major risk factor for heart attacks and strokes. Moreover, people who are sleep-deprived have elevated levels of substances in the blood that indicate a heightened state of inflammation in the body, which has also emerged as a major risk factor for heart disease, stroke, cancer and diabetes.  Other studies have found that sleep influences the functioning of the lining inside blood vessels, which could explain why people are most prone to heart attacks and strokes during early morning hours.[5]  The strongest evidence seems to be linking sleep deprivation to an increased mortality risk.  Otherwise healthy people who do not get enough sleep or who shift their sleep schedules because of work, family or lifestyle appeared to be significantly more likely to die sooner.

 How much sleep is enough?  Generally, experts recommend seven to nine hours per night.  But, as it turns out there is no absolute number of hours. Everyone requires more or less sleep depending on a variety of factors including your individual makeup as well as your lifestyle. What counts is that you are getting enough sleep for your body and mind to be replenished, whether that is six, seven, or eight hours or more.

[2] Nedeltcheva A, Kilkus J, et al. “Insufficient Sleep Undermines Dietary Efforts to reduce Adiposity”.  Ann Int Med. October 5, 2010

vol. 153 no. 7 435-441

[3] Cappuccio F, et al. “Sleep Deprivation Doubles Risks Of Obesity In Both Children And Adults.” ScienceDaily 13 July 2006.

[4] Redline S, Yenokyan G, et al. Obstructive Sleep Apnea- Hypopnea and  Incident Stroke.  American Journal of Respiratory and Critical Care Medicine Vol 182. pp. 269-277, (2010)

[5] Wolfe B, Volzke H, et al. Relation of Self-reported Sleep Duration with Carotid Intima Media Thickness in a General Population Sample. Eur J Cardiovasc Prev Rehab. Volume 196, Issue 2, Pages 727-732 (February 2008)

Well, let’s look at the facts.  Last year over half a million Americans suffered adverse events due to prescription medications.[1]  Almost 100,000 people die yearly as a result of complications from pharmaceutical drugs.[2]  To be sure, the FDA is under pressure to approve drugs faster, and they undoubtedly are under-staffed to review the $2.5 trillion worth of foods, drugs and medical devices they are currently responsible to oversee.[3]  But ultimately, it is the American consumer that gets hurt; and the pharmaceutical industry that lines its pockets with billions of dollars in the process.

In 1992 Congress passed the Prescription Drug User Fee Act, ostensibly to provide the FDA with desperately needed funds to make it more efficient.  The idea was to shift some of the cost of research involved in drug approvals to the pharmaceutical companies.   It essentially allows the drug makers to pay a fee to the FDA to approve their drugs.  This year, that user fee is estimated to be $920 million; nearly one third of the FDA budget![4]

Does that fee unduly influence FDA decisions?  It is hard to imagine that it wouldn’t.  The agency entrusted to regulate the pharmaceutical industry is now financially dependent on that same industry for funding.  Dr. David Graham, a senior drug safety researcher at the FDA who was pivotal in having Vioxx removed from the market was quoted as saying: “As currently configured, the FDA is not able to adequately protect the American public. It’s more interested in protecting the interests of industry. It views industry as its client, and the client is someone whose interest you represent. Unfortunately, that’s the way the FDA is currently structured.”[5]

Is there any evidence to back-up that claim?  Well, in the 40 years preceding the Prescription Drug User Fee Act, the FDA only recalled 8 medications it had previously approved.  Since 1992, that number is more than 22 drugs, and climbing.[6]  The latest drug casualty is Meridia, a weight loss drug pulled from the US market by its maker, Abbott Labs because it increases the risks for heart attacks, strokes and death.[7]  This isn’t the first weight loss drug to cause serious cardiovascular complications; remember Fen Phen and Redux?[8]  At least this time, the FDA eventually got it right by recommending Meridia’s removal from the US market.  It is troubling that European regulators banned it more than nine months ago.   What was the delay?  John Jenkins, MD, director of the Office of New Drugs at the FDA’s Center for Drug Evaluation and Research, suggested we need more weight loss drugs, “We’re still very committed to working with (manufacturers) to help them to develop and gain approval of safe and effective drugs to help patients manage weight”[9]

Last month I reported on the cardiovascular issues resulting in tens of thousands of deaths attributed to the diabetes drug Avandia.  It was banned in Europe but remains available in the US, albeit with tighter restrictions.[10]   There was a concern that diabetics would have fewer medication choices.  Really?  Type-2 diabetes can largely be prevented and reversed through lifestyle modifications.  But that approach would hinder profits.

Theses are just a few of the drug problems we know about.  More are likely to be recalled under the current approval system, and many remain on the market with dubious scientific benefit.  They continue to be prescribed in large part due to the weight of the pharmaceutical industry’s marketing initiatives to both physicians and the general public.  That is not to say that all pharmaceutical drugs are harmful.  Quite the contrary, there are tremendous life-saving medications available when needed.  But, many of the chronic conditions for which they are prescribed are preventable.

You may not hear that from big-pharma’s advertising, because it is much more profitable to treat symptoms with expensive drugs than to make you aware of the range of natural alternatives to prevent illness. Eat real food, not processed foods laden with chemicals and preservatives. Avoid sugars, starches and processed grains.  Drink more water.  Take high quality nutritional supplements; unlike pharmaceutical drugs, there are no widespread reports of deaths from vitamins.[11]  Exercise vigorously and regularly; it is the fountain of youth.  Get enough sleep to recharge and revitalize yourself daily; 7-9 hours are needed.  Learn to manage stress, enjoy more of your life, and keep things in proper perspective.

 Help is there but you must seek it out and make a commitment to the lifestyle changes necessary.  How do you want to live your life 10, 20, 30 years or more from now?  You can’t wait until then to decide.  What you do now will determine whether you remain vital, healthy and engaged in your later years, or whether you will be frail, feeble and drooling on yourself in a nursing home waiting for someone to change your diaper.  Which is your future vision?

[2] Moore, Thomas J., AB; Cohen, Michael R., RPh, MS, ScD; Furberg, Curt D., MD, PhD., “Serious Adverse Drug Events Reported to the Food and Drug Admin.,” Arch Intern Med. 2007; 167(16): 1752-1759

[3] Gardiner, Harris, “The Safety Gap,” New York Times Magazine Nov. 2, 2008

[4] Zajac, Andrew, “Freeze? What Freeze? FDA in Line for Another Budget Boost,” Los Angeles Times Feb. 2, 2010

[5] Loudon, Manette, “The FDA Exposed: An Interview With Dr. David Graham, the Vioxx Whistleblower,” Organic Consumers Association Aug. 30, 2005

[6] Center for Drug Evaluation and Research Report to the Nation 2005: http://www.fda.gov/downloads/AboutFDA/CentersOffices/CDER/WhatWeDo/UCM078935.pdf

[7] James W, Caterson I, et al.  Effects of Sibutramine on Cardiovascular Outcomes in Overweight and Obese Subjects. N Engl J Med 2010; 363:905-917. Sept 2010. 

[8]Curfman G, Morrissey S, Drazen J.  Sibutramine – Another Flawed Diet Pill. N Engl J Med 2010; 363:972-974 Sept 2010.

[9] Abbott Withdraws Sibutramine from Market. http://www.medscape.com/viewarticle/730155

 [10] 47,000Deaths and Counting. http://alternityhealthcare.com/2010/09/25/47000-deaths-and-counting/

[11] “No Deaths from Vitamins, Minerals, Amino Acids or Herbs,” Orthomolecular Medicine News Service Jan. 19, 2010; http://www.orthomolecular.org

 Low fat recommendations have been the mainstream message from such esteemed organizations as the American heart Association, the AMA and the USDA (creators of the food pyramid) among others.  The logic behind this school of thought seems intuitive.  Since increased blood lipids were associated with cardiovascular disease, and, cholesterol is a major component of arterial plaque, reducing dietary intake of saturated fats and cholesterol should remedy the situation.  In addition, fat is more calorie dense than carbohydrates, so eliminating fats from the diet should reduce caloric intake and result in weight loss.   There are, in fact, some clinical studies supporting the benefits of low fat diets on blood cholesterol levels and regression of arterial plaque.  This philosophy has been questioned in recent years.  An 8 year study of postmenopausal women eating a reduced fat diet over 8 years derived no significant benefit relative to cardiovascular disease, stroke, and coronary heart disease or CVD risk factors.[i]  As logical as the low fat diet seemed intuitive is the question:  if low fat was all it was purported to be, why over the last 30 years of low fat promoted diets and low-fat food products of every stripe, have Americans become more obese than ever, and cardiovascular disease remains the leading killer?

 The answer is based more on indisputable physiology and nutrition science than intuition.  Excess carbohydrates cause obesity, lead to insulin resistance, and signals the body to make and store more fats.  High carbohydrate meals, particularly simple, easily absorbed carbs found in sugar, pasta, potatoes or anything made with white flour, stimulate the secretion of insulin.  That insulin causes the carbs to be taken up by cells for energy but if not needed immediately, stored as fat.  That rapid reduction in blood sugar causes hunger which leads to more carbohydrate ingestion and the cycle continues.  As a result, blood cholesterol and triglyceride levels go up, thereby increasing cardiovascular risk.  Earlier this month, a randomized comparative study of low carb and low fat diets concluded that weight loss was comparable between the two but only the low carb diet reduced cardiovascular risk parameters.[ii]  Generally speaking, the low-carb approach is more satisfying and sustainable since it does not require limiting calories.  The fat and protein content keep you feeling full longer obviating the need to count calories.

 Is it just as simple as eating low carb?  Of course not.  No diet strategy taken to an extreme is good.  Individauls metabolize food substrates differently.  The diet that has most consistently been shown to reduce the risk of chronic diseases is a Mediterranean-style diet.  It is not low fat nor strictly low carb.  At Alternity Healthcare we make our recommendations are individualized and based on an extensive diet analysis, a thorough metabolic assessment and nutritional consultation with our registered dietician, Dr. Cassandra Forsythe.  Here are some guidelines:

• Eat real food – something grown or has a parent.  Something your grandparents would recognize as food.
• Eat healthy fats, such as omega-3 fats found in fatty fish (salmon, sardines), olive oil, nuts.  Fats should comprise about 30% of calories.
• Consume most of your carbohydrates from colorful fruit and vegetables
• Eat lean grass-fed meats, free-range poultry and wild caught fish
• Avoid simple, refined carbohydrates, sugars and artificial sweeteners
• Avoid trans fats and processed foods

[ii] Foster G, Wyatt H, et al. Weight and Metabolic Outcomes After 2 Years on a Low-Carbohydrate Versus Low-Fat Diet. A Randomized Trial. Annals IM August 3, 2010 vol. 153 no. 3 147-157