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OBESITY Associated with increased mortality Obesity in U.S. Average weight of men in U.S. in 1970 was 170 lbs.; in 2012 is 195 lbs. Average weight of women in 1970 was 140 lbs; now is 165 lbs. Overweight and obesity among children has increased. Obesity Fat cells produce leptin which decreases appetite and increases metabolism Obesity may be caused by a decreased leptin sensitivity ( ? Hereditary) Associated with an increased death from cancer, cardiovascular disease, sleep apnea, arthritis of hips & ? Knees, & diabetes Obesity CCK – an intestinal hormone that induces satiety – lack of sensitivity to this causes over-eating Ghrelin – a stomach hormone that stimulates appetite. Increases with any rapid loss of weight. Visceral fat – associated with heart disease (abdominal obesity). Willpower vs. genetics Weight loss (or liposuction) reduces fat cell production of leptin leading to increased appetite. Weight loss is contra to our evolutionary roots (hunter-gatherers). Grains, nuts and berries – very little meat and sugars. Energy storage was of utmost importance. Willpower vs, genetics Adopted twin studies indicate that 80% of variation in body weight is genetically induced. This may be from an alteration in the brain’s pleasure center (dopamine and serotonin), causing a craving for high calorie foods. Genetics is not necessarily destiny. Fats Hydrogenated (saturated) – needed for cholesterol, hormones, brain development. Non-hydrogenated (unsaturated) – liquid at room temperature. Trans-fats –super-heated nonhydrogenated fats, increase triglycerides and oxidants. All fats are high in calories (9 cal/gm) Carbohydrates Stimulate insulin secretion by the pancreas. Possibly promote insulin resistance Glycemic index – highly refined sugars do all the above. Needed for energy production and stored as glycogen in liver and muscles. Corn, sugar and beets (glucose, sucrose and fructose). 4 cal/Gm. Proteins Used to make cells (particularly muscle) > 20% make food unpalatable and overwork kidneys to preserve protein in blood. Present in egg whites, beans, nuts and lentils as well as meat and fish. 4 cal/Gm Toxic Environment Large portion sizes High calorie, sugar based drinks, high fructose corn syrup (stimulates insulin secretion and may lead to insulin resistance) High salt intake – may increase BP High fat content (9 calories / Gram) The number of meals consumed outside the home Obesity prevention Decrease calories ( CHO & Proteins have 4 calories/Gm; Fats have 9). Fats should make up < 20% of diet calories. Increase fruits, veggies and grains. Decrease portion size. Increase expenditure of calories (exercise). ( 30-60 minutes daily). The first law of thermodynamics applies – energy in = energy out or else it’s stored. Nutrition Energy – In = Out ; calories in = calories out to maintain weight Calories consumed = resting metabolism + activity – for men =900 + 10 X weight in Kgs. X 1.2 if sedentary; 1.4 for moderate activity and 1.8 for strenuous activity. Nutrition continued Calorie expenditure for women – 700 + 7 X wt. in Kgs. X 1.2 or 1.4 or 1.8 (depending on activity level). Composition of Regular diet: Protein = 20% of calories Fat = 20% CHO = 60% Water intake = 1.5 ml/Calorie (1000 ml = 1 Liter) 0 calories. Protein & CHO = 4 Calories/Gm. Fat = 9 calories/Gm BMI – body mass index <25 ideal, 25 – 30 overweight, 30-40 obese, > 40 morbidly obese. Waist circumference indicates visceral fat (men > 40”, women > 35”) . Nutritional Myths Eating before bedtime increases weight Fat can be removed from specific targeted areas Vitamin supplements are necessary, especially if “natural”. OK to lose weight quickly. “Carb” load before exercise. Vitamins A – 1000 ugm/day – stored, colored veggies B - 1 mg/day – excreted – beans, grains, meat. Atrophic gastritis, PA C - 60 mg/day - excreted , fruit D - 1000 IU/day - stored E - 8-10 ugm/day Vitamin B (complex) B 1 – (Thiamine) 50-100 mcg/d B 2 – (Riboflavin)) 10-50 mg/d B 3 – (Niacin, NA) 15 mg/d B 5 – (pantothenic acid) 50 ng/d B 6 – (Pyridoxine) 50-100 mg/d B 7 – (Biotin) 35-70 mcg/d B 9 – Folic acid – 500-1000 ug/d B12 – (Cobalamin) 100-1000 mcg/d Fatty Acids Omega 3’s – DHA, EPA, ALA – May benefit the heart (endothelium). How much? There are no guidelines. Salmon, tuna, trout and sardines (?Mercury). Walnuts, flaxseed ground or oil, eggs. Minerals Iron – 15 mg/day Zinc – 12 mg/day Iodine – 150 ugm/day Selenium – 55 ugm/day Calcium – 1200 mg/day Phosphorous – 700 mg/day Magnesium – 320 mg/day Folate (folic acid) – 400 mg/day Choline – 425 mg/day Salt NaCl – 2300 mgs.(one teaspoon) Most in processed foods Problem for those with heart or kidney disease, or high BP. Potassium – activates nitric oxide which relaxes arteries, tends to decrease heart disease. Present in fruits and vegetables. Phytochemicals Studies in rats show decreased fat cell growth and storage of lipids. Promotes fat cell death, but not cell production. “Soft” evidence. Resveratrol – red wine, grapes, blueberries, and peanuts. ? Decrease LDL & promotes endothelial “health”. Quercetin – apples, onions, red wine. ? anti-inflammatory & anti-allergic. More Phytochemicals Genestein – soy, garbanzo beans Lignans – flaxseed & grain ) may have estrogen-like properties). Anti-oxidants – broccoli, brussel sprouts, cabbage, tea (may protect against cell damage). Anthocyanidins – grapes, eggplant, radishes (ibid.) More Phytochemicals Ellagic acid – berries and walnuts (has antiviral and antibacterial properties). Carotenoids – yellow vegs and apricots ( ? “eye health”). Lycopene – tomatoes, red peppers and pink grapefruit ( anti-inflammatory and anti-cancer claim studies are inconclusive). Cooking or “processing” of food may destroy benefit, if any. Phytochemical foods Nutritional prevention There is no solid evidence, but “evidence suggests”: 1.Breast Cancer – increased by animal fat (red meat) 2. Heart Disease – saturated fats; ? Antioxidants ( but not Vit E or B – carotene) 3. Age related macular degeneration - ? Carotenoids (broccoli, kale, spinach) 4. Immunity - ? Low saturated fat ; fruits and veggies, exercise 5. Overall – IBW, exercise; decrease refined sugar, red meat and trans fats (fried food) Vitamin D Age related Increase in BP significantly higher in Vit D deficiency Skin + sun = 90% of Vit D (10,000 IU/day) Vit D from food (fish, eggs, milk)=10% Vit D status normally = >30ng/ml Vit D deficiency = < 20ng/ml Vitamin D Metabolism Vitamin D from skin goes to liver where it is converted to 25 , OH vit D (D2), then to the kidney where the bioactive form, 1-25 OH Vit D (D3) is made. Vit D2 is measured, but appropriate levels are not well established. Vit D supplementation Vit D deficiency linked to cancer, CV disease, depression, dementia, autoimmune disease and more. Only musculo-skeletal health is supported by evidence (falls and hip fractures). Serum Vit D2 @ 27.5ng/ml. Vitamin D Deficiency Rx 1000 IU / day or 45,000IU/month Toxicity > 10,000 IU/day – may cause high blood calcium level Vit D supplementation for other than musculoskeletal reasons is not adequately supported by evidence. Vit D is a marker (association) for some illnesses, but cause and effect has not been established (no RCT’s) What About Supplements? Vit E (anti-oxidants)- Associated with an increased risk of death. Increased rate of prostate cancer. Vit A – increased incidence of lung cancer in smokers, and prostate cancer in men. Vit D – decreases fractures, but >70 one study showed increased risk of falls. Vit C – no reduction in cancer, CV disease or URI’s. Multivitamins – 38,772 women found an increased mortality in those regularly taking multivitamins. Long term consumption of any biologically active substance should not be assumed to be free from risk. A “Healthy” Diet A pattern of eating that fuels the body without weight gain. Avoid thinking of food as a source of pleasure. Food is fuel and nutrition. Eating is a comprehensive behavioral activity. Changing behavior is a lifelong endeavor. Retrain the brain to decrease the “reward value” of food The Moral of the Story The Japanese eat very little fat and drink very little red. wine and suffer fewer heart attacks than the British or Americans. The French eat a lot of fat and also suffer fewer heart attacks than the British or Americans. The Italians drink generous amounts of red wine and suffer fewer heart attacks then the British or Americans. Conclusion Eat and drink what you like. It’s speaking English that kills you. Post hoc ergo propter hoc. Associations are not causes.