Metabolic Obesity: Redefining Fat

When many of us think of fat, we picture folds and rolls that jiggle. The fat that the health and beauty industries market toward is that which is under the skin, otherwise known as subcutaneous fat. It’s the same fat that puckers through weak connective tissue grids creating what we call cellulite. While this fat is concerning from both an aesthetic and health oriented perspective, there is a far more insidious kind of fat not always visible on the outside who is responsible for a host of diseases in the long term. This fat is not assessed by volume like those caliper pinching tools used to tell you your overall body fat %, but by location. This is your deeper fat reserve – your visceral fat.

The how to of measuring one kind of fat…caliper in action

Visceral fat (also known as brown fat or metabolic fat) gets its name because of where you find it – nestled deep in the abdominal cavity surrounding organs (i.e. viscera) like the liver, intestines, pancreas and kidneys. It’s there as an energy back up for your vital organs as well as to cushion and protect them. Your body is hardwired to maintain this fat, unless there is a deficit (i.e. starvation or intense exercise). In fact, even when not starving, this fat produces substances that affect insulin levels and communicate with the liver to influence blood fat content ensuring that the vital organs always get fed. In a famine, this fat will be the first to go before your body resorts to breaking down surface fat, muscles and organs for fuel. Now, imagine that you have more than what you need of this highly active fat? It pumps out pro-inflammatory cells into your blood stream, since it has a tight relationship with a major blood vessel to the liver and heart. These cells cause insulin resistance which is the precursor to Type II diabetes as well as promote the development of heart disease, atherosclerosis (hardening of the arteries) and cancer of the bowel. Research even suggests that visceral fat increases production of the stress hormone, cortisol, and reduces levels of feel-good endorphins, leaving you feeling low on so many levels.

Being that it is so metabolically active, plentiful visceral fat is not the easiest to get rid of. This is also why people who have excess are now being termed metabolically obese regardless of whether they look lean or large. The tell tale sign of this excess in most people is the gut. While the gut is more prevalent in men who tend to have more fat stores in their belly region due to their hormones, menopausal women can also display this type of distention. Waist circumference will give you an inkling as to whether visceral fat is high; 35 inches or more in women and 40 inches and above for men. Another factor that affects visceral fat accumulation beyond gender and hormones is heredity/ethnic background. If people in your family tend to be apple shaped, meaning that more of their fat resides in the upper body, chances are your visceral fat is going to be higher. Following patterns amongst ethnic groups, it was found that excess visceral fat pops up in white men, African American women, Asian Indian and Japanese men and women most often. In addition, certain environmental factors play a role such as smoking and the consumption of compounds in food that mimic estrogen. Known as xenoestrogen or “foreign estrogen” they enter the body through the eating of plants and meats that have been exposed to or naturally contain these compounds and wreak havoc on hormonal levels which mess with visceral fat accumulation. However, many people suffer from metabolic obesity, as I noted earlier, without any outward sign of a large tummy. In fact, they might look pretty lean to the naked eye and register BMI’s that are in normal range.  The only way they find out their visceral fat is high is through an MRI or CT like scan, where the fat’s location can be clearly seen, as demonstrated in the below image. Of course, this is a costly test that is not always accessible or covered by insurance.

MRI Scan done in Britain of an outwardly thin person, who clearly has a large amount of visceral fat, as seen in the white regions of his abdomen (http://www.telegraph.co.uk/news/uknews/1536556/Get-in-touch-with-your-inner-fat.html)

 

So now that your perception of fat is altered, what can you do to reduce excess visceral fat? A 2007 study indicated that High-Intesity exercise was most effective when done at least 4-5 hours a week. Another added bonus for some of the individuals taking part in this study, when combined with dietary tweaking, was an overall reduction of their subcutaneous fat % thus putting BMI levels in normal range. I can’t think of a better prescription than food and exercise. Of course, the best people to consult with for said script would be a nutritionist or registered dietician and a personal trainer. The former for an overhaul of your diet and eating habits and the latter for the right training regimen. My personal feeling with respect to trainers is to do your research and look for someone who has a strong background (cumulative experience and/or degree) in exercise physiology or kinesiology to construct a program of exercise that best suits your body, fitness level and individual goals. Physical therapists and doctors that specialize in sports medicine can be great sources for referrals of this kind.

 

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Psychosomatic Medicine

Acupuncture chart from Chinese medical text circa 1340s A.D.

There is nothing worse than going to a doctor with a host of symptoms and being told there is nothing wrong with you. Many people who appear on the program, Mystery Diagnosis, (my second Discovery Health obsession next to the The Food MD) have had this experience. I recall one particularly disturbing episode, where a young woman complaining of extreme gastrointestinal distress was prescribed an anti-depressant by one of the many doctors she sought answers from. Confused, she asked how these would help her to which the doctor responded that her condition was basically all in her head. When a physical illness or condition is caused by or aggravated by a mental factor it is termed psychosomatic. Essentially, that is how this young woman’s doctor viewed her illness. Many years later, she was properly diagnosed with severe endometriosis, a condition where the cells of the uterus grow in other places of the body causing cramping, severe bleeding and infertility to name a few. In her case, the cells had grown into and over parts of her GI tract. She had a full hysterectomy and a section of her large intestine removed in order to reclaim some quality of life. Take that, anti-depressants!

As you can glean from the above story, defining an illness as psychosomatic carries with it an intense social stigma here in the west, even though almost all physical illnesses have mental factors that determine their onset, presentation, maintenance, susceptibility to treatment and resolution. When doctors dismiss symptoms like in the case of this young woman, the rest of the world follows suit. The person who is suffering internally and externally is labeled “dramatic” or even worse, a liar. For thousands of years, Chinese medicine viewed the psychosomatic as the greatest key to diagnosing deeper illness and imbalance in the body. The strength of the nervous system and physical state of the individual (including their environment) is assessed in order to understand the degree in which an organ or a system is affected. Every symptom is taken into account and treated seriously, with the objective being to restore balance. Moreover, the eastern approach considers how interconnected the body and mind are.

The biggest physical bully is emotional stress, which can infiltrate suddenly or slowly, over a long period of time. Even from a western perspective, stress can be incredibly destructive, wreaking havoc on connective tissues, digestion, vascular integrity and the body’s restorative sleep cycles if not managed properly i.e. not just a script for anti-depressants. In Chinese medicine, if the nervous system of the individual is weak, the symptoms of illness will be more psychological. On a physical level, the organ most affected by the emotional stress will be the weakest/dysfunctional one. Whatever the natural emotions associated with this organ are, they will become stronger and more destructive to the nervous system overall. As the organ breaks down, it takes the system it is associated with along for the ride, leading ultimately to disease. If the emotional stress comes on suddenly, it will affect the Heart and the Lungs. If it is gradual and long term, it will take a toll on the Liver, Spleen and Kidneys. Even more specific is the type of emotional stress broken down into these 5 categories: tense/chronic, shock/sudden, sadness, rumination and fearful emotion. This gives an even more precise view of the affected organs/systems in the body, further honing the treatment approach.

Our young woman with endometriosis would have been assessed as having a strong nervous system in the beginning, as her symptoms were predominantly physical. By the time she had gone to see the doctor who prescribed the anti-depressants, she was exhibiting a combination of physical and mental symptoms. This would signify that her nervous system was deteriorating. If she had also gone to see an eastern doctor from the get go, much of her later suffering might have been alleviated, as the weakest organ, her large intestine would have been addressed immediately with herbs and acupuncture/bodywork. Since organs are partnered in the Chinese system of yin/yang (solid/hollow), the untreated large intestinal dysfunction would have affected her lungs. This woman developed an eczema like rash all over her trunk and extremities that would get worse every time she had a violent bout of diarrhea. The skin is considered the 3rd lung of the body in Chinese medicine. This symptom developed 5 years after her initial bout of gastrointestinal distress. After ten years, she began to bleed copiously during her period, which lasted over two weeks. Initial blood tests had already indicated she was mildly anemic, but this massive blood loss rendered her immobile. Ironically, during this time, her large intestine dysfunction seemed to dissipate; however, as soon as the period would end, the violent diarrhea would return. At this point in her illness, the Spleen had become involved. Responsible for creating Blood/Qi and keeping things upright and in their proper place, it’s no wonder that when she finally got her diagnosis 15 years in the making, this was the most affected organ. (Note: One could even argue that the Spleen could have been the weakest organ overall, but I won’t complicate things for the reader) The cells of the uterus growing out of control outside of their proper place is demonstrative of Spleen weakness. The uncontrollable bleeding led to a massive loss of Qi that just couldn’t be replaced by her depleted system. The only solution, at that point, was to remove the uterus and large intestine to prevent the out of control cell growth from migrating elsewhere. While organ removal can have detrimental affects on the Spleen, it proved more harmful to keep the stagnation in there than to remove it. If I were this young woman, I would seek out an acupuncturist to help me keep my nervous system strong and balance the loss of the organs that were surgically removed. They would be able to recommend herbs and dietary changes to support her treatment. After watching this episode, it made me all the more fired up about Integrating Eastern and Western medicine. If East met West from the beginning, she and others like her would have been spared a lifetime of suffering. We would all have a better understanding of our body-mind relationship and keep the stigmatic tongue wagging at bay.

SOURCES & ADDITIONAL READING:

http://www.dragonrises.edu/learning-opportunities/articles-books/

http://www.psychosomaticmedicine.org/

A big plate of Sleep

Many health and nutritional experts say that breakfast is the most important meal of the day, but I beg to differ. Let me draw your attention to the period of time that precedes that meal. A time that should be spent in a state of deep restfulness. Doing without this form of nutrition will set your body up for certain demise. Sleep is the meal that should never be skipped.

Our appetite for sleep is programmed into a part of the brain known as the hypothalamus, which is the regulating center for the various biological drives that keep our bodies functioning. When we are infants, the part responsible for sleep and wakefulness is out of control. Think of how many babies sleep all day and are up all night or those that have short bouts of sleep spread out over an entire day. The reason for this insane sleep schedule is the immaturity of the internal clock that sets daily functions to the rhythm of 24 hours. Human beings have it, as do plants, animals, fungi and certain bacteria. Dubbed our Circadian Rhythm, sleep and wakefulness is dependent on exposure to light and dark. The first few months of life are pivotal in establishing this internal rhythm, but some babies take as long as a year to sleep a solid 8 hour night. Once the rhythm is established, your body will function on a 24 hour cycle. When in the presence of darkness, our brain’s pineal gland, which is light sensitive, produces a hormone melatonin that helps to make us sleepy. Desire for sleep is strongest during the darkest hours between midnight and 6 a.m. and to a lesser extent in the mid-afternoon. In American culture, this is the 2-4 p.m. slump when most people grab themselves a coffee and/or some kind of energy boosting snack. In Europe and Latin America, this would be your afternoon nap-time otherwise called the “siesta.”

National Nap-time is the right idea! (Image of the first ever Sleeping Championship in Madrid, Spain 2010)

Sleep itself is a highly involved process consisting of 4 stages that each have a physiological affect on the body and brain. The first three stages are part of what is called Non-REM or quiet sleep, a state where thinking and most physiological activities slow down, but movement can still occur, and a person often shifts position while sinking into deeper stages of sleep. Unless something disturbs the process, people will pass through these 3 stages of sleep smoothly. The fourth stage of sleep is called REM or dreaming sleep, a state where the brain is very active, but the body is paralyzed. Normal sleep cycles alternate between quiet and dreaming, with most deep sleep occurring in the first half of the night. During the second half of the night, dreaming sleep gets much longer and alternates with the second stage of quiet sleep. More on these stages now…

During the first stage of sleep, dubbed drowsiness, your brain no longer receives visual stimuli from your shut eyes, body temperature begins to drop, muscles relax, and eyes often move slowly from side to side. Although you may start to lose awareness of your surroundings, you can very easily be awakened. In the second stage of sleep, known as light sleep eyes remain still and breathing and heart rate are much slower. The brain starts to show irregular electrical patterns of slow waves and short bursts of activity. The brain can also respond to outside stimuli, like someone whispering your name, which scientists believe could be a built in vigilance system to ready you for awakening if necessary. Half of a good night’s sleep is spent in this stage. Once you enter the third stage of sleep, known as deep sleep, your body undergoes some important cellular changes. Blood flow to the brain decreases and it stops responding to outside stimuli, making it difficult to wake up the sleeper. Breathing becomes regular, blood pressure falls and the heart slows to 30% of its waking rate. The pituitary gland releases growth hormone at the beginning of this stage which stimulates tissue growth and muscle repair. Proteins in the blood that activate your immune system also increase, helping build the body’s defenses against illness and infection. Interesting side note here: People in young adulthood have many stretches of deep sleep, while those over 65 have none.

Enter now the fourth stage of sleep or dreaming sleep where the eyes dart back and forth rapidly behind your closed lids ( this is where the acronym REM comes from standing for “rapid eye movement”) and the brain races with thoughts and “dreams. Your body temperature and blood pressure rise, and your heart rate and breathing speed up to daytime levels. What is interesting is that the sympathetic nervous system, our fight-or-flight response, is twice as active as when we are awake. Despite all this activity, the body hardly moves, except for intermittent twitches. The rest of the muscles not needed for breathing or eye movement are essentially paralyzed. A normal night’s slumber consists of 3 to 5 approximately 90 minute periods of REM, but as we age they get shorter. Many scientists feel this is the time when the mind restores itself, which is important for cognition and memory. Early research into the role of REM sleep in-utero indicated that the rapid firing of nerve cells during this period was important for the growth and development of nerves. Subsequent studies on adult humans found that REM sleep deprivation led to poor performance on a variety of recall tests or logical tasks. In addition, memory loss occurred when sleep was deprived on the same night or two nights after the material had been learned and especially when subjects had been selectively deprived of one of the first two or last two REM episodes of the night. In other studies, REM cycles were found to increase after complex material had been studied, indicating that the brain uses this time to sort and process information into its memory banks. Other scientists suggest that REM sleep functions to dispose of unwanted memories through a mechanism called reverse learning. Reverse learning operates during this period of sleep to prevent the brain from being overloaded with massive amounts of information stored during wakefulness. A fine explanation for the insane dreams one may have, but testing this is pretty difficult, so it’s just a theory.

If your sleep is going to be interrupted, you do not want it to be during your stage 3 and stage 4 cycles. Overtime, deprivation of these levels of restorative sleep will take a toll on your outward appearance and your internal health, mentally and physically. Dermatologists have noted that collagen production increases during sleep, strengthening the bond between your exterior and deeper skin layers and allowing for the water retention necessary for suppleness. Also, growth hormone gets released in deep sleep, as mentioned earlier, which builds and repairs tissue. Without it, water evaporates from the skin leading to a dry, sallow complexion and the appearance of fine lines. Keep it up and skin could react with rashes and eczema. Lack of deep sleep increases the amount of inflammatory proteins in the blood and decreases immune system response. The more deprived you are, the more likely it will be that your body will react to pathogens and itself. The increased inflammatory proteins can lead to such conditions as heart disease and overall, research has indicated that people who get less than 6 hours of rest a night tend to have a higher mortality rate than those getting the recommended 7-8 hours. If you are a person who weight trains or exercises a lot, the lack of deep sleep does not allow for muscles to repair themselves and grow properly. This negates the affects of the workout and leaves them prone to injury. Outside memory loss, deprivation of REM sleep can lead to a diminished awareness of one’s surroundings, a severely reduced response time and an inability to perform tasks that are highly involved, such as driving or operating machinery. Far beyond drinking and drug use, lack of sleep is responsible for most of the accidents that occur on America’s roadways.

 

If you are having trouble getting to sleep at night, some of the obvious culprits could be stress, use of electronic equipment before bed, drinking too much caffeine and eating a big meal or going to bed hungry. Those have easy solutions, relatively speaking. You can get a massage, meditate or do some yoga to relax your body and bring your mind down from its stressful state. Have your coffee earlier in the day and cut down on the amount. No eating of large meals or snacks within 2 hours of going to bed, so you have ample time to digest. Shut the computer and the television and get them away from the area dedicated for sleepy time. Plunge yourself into darkness (remember that melatonin) and relative warmth, and sleep should come to you. However, there are some not so obvious culprits for disturbance of sleep. Check these out:

  • Taking a B vitamin supplement before bed – The B’s are super important for stimulating the nervous system, so popping supplements before bed can lead to fidgeting and constant awakening because the brain is way too “ON” to enter deep sleep.
  • Having a few drinks in your system – While it might get you to sleep faster, alcohol impedes the natural cycling of sleep stages, plunging you into what feels like deep sleep right away, but wearing off in the second half of the night when your REM cycles start kicking in. Since you never get to REM, you wake up more often than not feeling groggy, achy and depending on how much you drank, possibly still drunk.
  • Taking Prescription medications – Consider that sleep disturbance is a common side affect of some high blood pressure pills, birth control pills, steroids (including asthma inhalers), diet pills, antidepressants and cough and cold medications.
  • Smoking – Nicotine is a stimulant like caffeine so depending on how much you smoke and for how long, sleep can be dramatically reduced.
  • Working out at night – Some work schedules do not allow for morning or midday exercise, so many people will go to the gym after work. Exercise raises epinephrine levels in the blood, which makes us more alert and overall body temperature. These 2 factors can prevent sleep.
  • Hormonal changes – Long before menopause has kicked in, many women find they wake up in the night numerous times. This is due to fluctuating levels of estrogen and progesterone. Some younger women suffer from erratic sleep patterns before or during their menstrual cycles due to imbalances of these hormones.
  • Sleeping in on the weekends – It’s good for the circadian rhythm to awaken and go to sleep around the same times each day, but many of us tend to stay up later and sleep in more on days off. This throws off your internal clock, making it harder to fall asleep and awaken when faced with your normal schedule. Doctors suggest to sleep no longer than an hour more than you normally would in order to maintain the cycle.

Lastly, if you are chronically deprived of sleep despite your best efforts you should really think about visiting a doctor and/or finding a sleep clinic in your area to better assess and diagnose your problem. Now, go get a heaping helping of rest please!

 

 

What your poop has to say about your health

The practice of Haruspicy is common amongst African tribes. It is the practice of studying the entrails of a freshly sacrificed animal to tell the future – wealth, health and many cattle being the optimal reading. Of course, when it comes to Western society, all matters of the intestinal kind are barely discussed unless within the framework of a crude joke or when pressed by one’s gastroenterologist. Forget about looking into the toilet after the deed is done. All we want to do is flush.

Thankfully, in my family, all we ever did was examine and discuss. There is a saying in Greek that a person either dies by way of their head (i.e. mind) or their ass (i.e. intestines). Hence, the daily dose of TMI over breakfast and/or dinner. Based on my experiences and research, here are some of the things you should ask of your bowels followed by a cautionary tale.

Did you go today?

A human being should defecate at least once a day, but if your track record is less than 3 movements per week, you are officially constipated. Since the bulk of water absorption happens in the large intestine, the longer your poop stays in there the more water gets absorbed out of it and the tougher it will be to pass. Dietary issues that may cause constipation can include inadequate water intake; inadequate fiber intake; overuse of coffee, tea, or alcohol; a recent change in your diet; and ignoring the urge to defecate. Reduced levels of exercise may play a role as well. Other factors to consider are psychological issues such as depression, anxiety and eating disorders as well as medications whose side effects mess with the natural flow of things.

What should it look like?

Reference the amazing Bristol Stool Chart, a medical aid created by a doctor at the University of Bristol, England to classify human poop into 7 types. Types 1 through 3 indicate constipation. Normal poops are classified as Type 4 and 5. Types 6 and 7 indicate diarrhea and its precursor, respectively.

I love this thing!!!

Frequent bouts of constipation and/or diarrhea can be a warning sign/symptom of a number of conditions, such as IBS (Irritable Bowel Syndrome) and Celiac Disease. If diarrhea  lasts for more than a week, it can cause an electrolyte imbalance due to all the potassium and sodium loss. If not treated properly, that imbalance can lead to death. Listen to your poop and see your general practitioner if any of the above is the case.

What color is it?

The stool color spectrum is even more informative than the Bristol Chart. Heaps of information on one’s health habits can be gleaned from the color of their poop. Here are the notable ones.

Brown = Normal
You want your poop to be within the middle of the brown shade spectrum. This normal shade comes from bilirubin, the yellow biproduct of broken down blood cells, that enters the intestine by way of the liver and helps color the poop. It also makes our pee yellow in color. Darker brown poops can be a result of excess salt in one’s diet or from constipation.

Black and Tarry, better safe than sorry!                                                                                       Blood, when digested, looks black and has the consistency of tar. The bleeding could be an indication of a stomach ulcer, a bleed somewhere in the upper GI tract or even cancer. Certain ingredients in medications and vitamins containing heavy doses of iron can also produce such poops. Best to visit your MD as soon as you become aware of this ominous color.

The Anemic Poop

If your movement is very light, almost grey in color and you didn’t just have a colonoscopy, then you may be experiencing some kind of blockage of a bile duct, gall bladder dysfunction and/or even liver disease.

Yellow like a newborn babe

Newborn babies that are breast feeding tend to have frequent poops that are yellow and slick in color because their bowel system is so fast and the content of their meal so fatty. Poop of this color and nature in adults can mean a few things. Assuming you haven’t consumed a whole lot of beta carotene rich foods or candy dyed with artificial yellow coloring, it could mean fat is not being properly absorbed and therefore, is getting excreted through the bowel. The poop will also stink to high heaven and float on the water’s surface like an oil slick. If you have recently traveled to a developing area of the world, it can also signify an infection known as Giardiasis, caused by a parasite that gives you yellow diarrhea. Another condition that causes poop to come out yellow is Gilbert’s Syndrome which is an excess of bilirubin, also making the person look jaundiced.

Going Green

If you are a person who loves their leafy vegetables, your poops will obviously represent that. But if your body is moving food too quickly through your system, as in the case when you have diarrhea, bile does not have sufficient time to breakdown and stays in the poop, dying it green. Also iron supplements can stain poop green (in higher concentrations, black) too. If you are going green consistently, you may want to get your liver/gallbladder checked out.

Now where things get a little serious…A Cautionary Tale of Colon Cancer:

For years my father dealt with bouts of constipation stemming from what he self diagnosed as a “bad stomach.” In his youth, he had very poor nutrition, as his family lived in abject poverty. Upon his 12th birthday, he left to work on the cargo ships where he ate whatever was canned and salted amidst dank conditions and constant stress. In his early twenties, he came to the U.S. and ate one meal a day while working 12 hour shifts at a restaurant. He worked like an animal going from dishwasher, to busboy, to food runner, to line cook and finally, head cook of a high end Greek eatery. Then he bought his own restaurant along with two other friends. The workload should have been divided by three, but my dad ended up working 24 hours shifts. He lived on black coffee and inhaled meals on the go. When he got married to my mom, issues with his partners ended up forcing him to carry the restaurant himself. He had to be everywhere at one time. He was always under slept, stressed and constipated. When he did poop, it would be very hard to pass or would come out in ribbon like pieces. He dropped to 125 lbs. He looked scary. Solution: my parents sold the business and moved to Greece. He ate well. He basked in the sun. He gained weight and pooped like clockwork. Everything was great, except for one detail. Island life in Greece circa 1980 was something my mother could not handle with two babies. There was only one phone in each village, no indoor plumbing and limited access to the things needed to take care of us. She wanted to go back. My father listened. In the years that followed, my father worked from scratch again, since the restaurant was sold before we moved. He learned he had an ulcer in his stomach. He had kidney stones. He was constipated. He put himself on special “diets” to cleanse his bowels and calm his sour stomach. He was angry and stressed all the time. Life was not pleasant. Then he retired from all work when he turned 50. Despite the lack of work related stress, he was still angry and preoccupied. The patterns of constipation continued throughout the rest of the 90’s and in the first decade of 2000’s. This past December, after experiencing some intense pain on his left side and being unable to eat, he went for his first colonoscopy. It indicated adenocarcinoma, the cancer that typically occurs in the colon. Thankfully, it was still in stage 2 and operable. He is now doing chemo, eating super well, and gaining back weight and energy. The doctors feel optimistic that he beat it. My point of outlining his whole story is that had he paid attention to what his colon was telling him all along with the bouts of constipation and digestive issues, he would have changed his lifestyle and eating habits for the better. He is lucky. Had he refused, as many old school European types tend to do, to go for that colonoscopy, he probably would have been well into stage 4 before it was detected. It would have been too late.

Listen to your poop…it could save your life.