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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The Food MD

The American audience has been saturated with advertisements for Pharmaceutical products since the mid-nineties. Whether it’s in print or on the screen, anyone can find a drug to address a multitude of symptoms a la Ray Bradbury’s “Farenheit 451.” Fast forward through the gently spoken side effects and the advice to “consult with your doctor before taking…” and most people presume life will be brighter, happier and glossier when on this drug. Oh, behold how gray propaganda works.

It’s a full body experience, alright!

In response to all these scripts is “The Food Hospital,”a program that airs on the BBC’s Channel 4 and The Cooking Channel here in the States. It explores the science behind using food as medicine. Patients with conditions and/or a variety of symptoms come in, are subject to a battery of scientific tests after which a food regimen is prescribed and monitored by its doctors to see if it can effectively treat them. During their follow up visits, patients and doctors meticulously review how the different foods eaten helped them through hematocrits (i.e. blood tests) and feedback, then compare the statistical results from the prescription drug alternatives. Sometimes the patients have already tried all the drugs on the market for their condition, so the comparison is first hand; however more often than not, the food program has the most profound impact sans side effects.

If we think about our history, man has always looked to nature for methods of disease prevention and curing sickness. There are still people in remote tribes using things like tree bark and crushed dung beetles to treat infection. As we cringe and contort our faces in disgust, an incredible thing occurs – the treatments WORK. I should remind you that many new medications being developed in pharmaceutical labs have their roots in botanical and organic sources, sometimes emerging from rainforest and bush treatments.  Of course, by the time the medication makes it to market, those sources have been altered and incorporated with a multitude of synthetic agents. Bring on the light colored pill and its numerous side effects. If, however, you knew that changing what you put inside your body could help treat you, which would you gravitate to?

A young woman suffering from debilitating PMS found that incorporating more calcium rich vegetables like broccoli and dark leafy greens into her diet helped to eliminate the severity of her symptoms. Prior to visiting the Food Hospital, her only medical option was taking an anti-depressant. For other conditions, the food prescription is a little more involved. Take, for example, the Portfolio diet, which is a vegetarian diet consisting of a four key cholesterol lowering foods that bring down the levels of LDL, considered the “bad” cholesterol. This “portfolio” consists of soluble fiber, (examples include oatmeal, oat bran, barley, peas, beans, lentils, psyllium, and vegetables such as okra and eggplant) nuts, soy protein and margarine enriched with plant sterols. It can be a challenging diet, but incredibly effective. In fact, its efficacy has been comparable to that of prescription drug Lestatin. Also in that vein of challenging yet effective is the Low FODMAP diet which is prescribed to people suffering from IBS (Irritable Bowl Syndrome). The science behind this diet is that consumption of foods with high levels of fermentable sugars end up creating more liquid and gas in the gut, thus leading to the uncomfortable symptoms experienced by those who have the condition. Foods with low levels of these sugars and especially when eaten in certain combinations and amounts have been found to drastically reduce  digestive distress. Since current prescription medications for IBS have varied results and obvious risk factors (think of the recall in 2000 of Lotronex after some users died as a side effect), it’s sort of a no-brainer to go the route of Px Diet. If you never thought food could have this kind of profound impact on health, then start thinking it NOW. Just note that none of the above diet programs or other ones should be undertaken solo. The script needs to come from a registered dietician and/or doctor’s referral.

Happy eating!

A Body is a Terrible Thing to Waste

All bones, no strength – Anorexia circa 2003

October 13th was the 8th anniversary of my recovery from Anorexia. Back on that date in 2004, I broke down on the floor of my bedroom in the middle of the night. I was staring into the demon bowels of the disease that had dictated my life for 3 years. It sucked the air from my lungs. I couldn’t live another day with its crushing pressure. It took me two weeks to leave the confines of a friend’s home (where I had escaped to cocoon myself from reality) and once I did emerge, I felt like I was in some kind of silent film. The world moved slowly, while I felt frenetic. I quit and distanced myself from everything in my life that I had allowed to enable the disease. I went into therapy. I ate a bowl of black eyed peas and rice, my first meal, with trepidation. My stomach; my intestines; my mind slowly came back to life. With belly distended, I proudly proclaimed on whatever social networks existed at that time that I was recovering. I was still very thin, but by the New Year 2005, my consistent eating led my body to “betray” me.

Performing in 2007, at my heaviest post recovery (Image copyright: Gary Winter)

The life preserving shut down of my metabolism was meant to make sure I wouldn’t starve again. I was afraid to eat, but I did anyway. I submitted my food journals to my therapist who approved and told me to eat more. “Variety” she stressed, but I was fixated on foods I felt safe with. I did gratuitous amounts of cardio at odd hours, so no one would stare at my body at the gym. They had known me when I was at my thinnest and I feared their assumption that I was letting myself go. My fears were realized when in the Spring of that year, a trainer approached me and offered to give me a fitness assessment. The masochist in me accepted and after running his various tests, proclaimed to me that I was borderline obese. Oh, the shame that washed over me. For years, that left me with such an acrid taste for personal trainers. He told me to cut out the “junk food” and come see him for sessions at the gym. I was living on tuna fish and pita breads, fueling my workouts with coffee and bee pollen smoothies. I never went back to that gym. In fact I stopped going to any gym. My weight and health habits fluctuated erratically between 2005 and 2008, until a good friend recommended his trainer. I got over myself and the shame I had felt in my previous experience and contacted him. He assessed me through a short circuit of activities and introduced the concept of strength training. He taught me how muscle mass and strength would benefit me in the long run, making my metabolism more efficient and letting my body reshape itself into it’s own “normal.”

All muscle, all strength!

The seed he planted germinated when I went back to school for massage. I was hit with Anatomy, Physiology, Neuro and Kinesiology. I never soaked up information with such appetite before. I couldn’t get enough. This knowledge enhanced my workouts and sessions with my trainer because I understood how my body was designed to function. Suddenly, Mr. “Borderline Obese” became the joke that I should have never taken seriously. (Side note here: I saw his picture and name on a real estate placard recently, which clearly shows us he did not have a glowing career in exercise physiology after all). I also returned to therapy with a more cognitive approach to help get to the root of my control issues and take them head on…much like throwing knees and elbows during pad drills. I channeled my emotions into my workouts and learned, often times the hard way, what an art BALANCE is. Now, as a massage therapist, it is so important to foster this healthy sense of bodily awareness within my clients, wherever possible and always when solicited.

So when I was contacted recently by a Fitness/Wellness website for a review of their services, I stepped up to the plate and joined. SlimKicker is a point based program kind of in the vein of Weight Watchers, except that it values activities and nutrition at various levels and creates challenges for its users to foster long term health habits. It also provides a calorie counter, fitness tracker and other resources. There is the community aspect too, as users can post inspirational feed on the homepage, join each other in challenges/groups and “friend” each other for support. The About Us section states that the site is all about learning proper nutrition, portion control, and acquiring important habits. In that vein, upon signing up I was asked for my weight and what my goal was – weight loss or strengthening/toning. Although I chose the fitness oriented option, the pop up that followed was more for weight loss, citing how many calories and percentages I needed to consume in order to achieve my goal. The amount it noted was no where near what I would need to fuel my body and my workouts. To drive this point home, I logged only my exercise habits; not my food intake. If I followed what the site suggested, I would essentially send my body into starvation mode.

It is important to note here that there is a disclaimer in their Terms and Conditions that states the site should not be used by anyone with any medical or nutritional conditions and that content is for informational purposes only, not meant to replace professional medical advice. Obviously no one with an eating disorder has any business on a site where everything is meticulously logged and counted, but many people without said issues can still have disordered eating habits and cycles of guilt they feel compelled to share via social network. The site’s inspirational feed is 80% laments at having eaten too much of something labeled “bad” either by the user themselves or the nutritional information offered to them by the website (Remember that disclaimer,guys?). Also, there are statements of pride over extra exercises and completed challenges; however these inspirational statements are edged with complaints about weight gain or lack of loss (again, that disclaimer). This is not the site’s fault. They want you to be positive, stay focused and band together for support. Our society is more to blame for fostering this widespread self loathing and depreciation. The hate and guilt are infectious and breed a vicious cycle that will continue so long as we choose to continue “sharing,” despite any health oriented social networks best efforts.

SlimKicker, if used properly, can function as a motivator for adopting a fitness regimen because it holds you accountable for your activities. Much like a TO DO list, if exercise is factored into a week and logged daily, it makes you all the more aware of the need to check it off your list. After doing so for so many times, it will hopefully become a natural part of your daily lifestyle. I’m still not a fan of food logging due to my past; however if you truly don’t know what you have eaten in a day, keeping a food diary can help you track unhealthy patterns like over eating and of course, under eating. My advice is to pay attention to your body’s individual needs and seek out a registered dietician and/or nutritionist if you find the process to be overwhelming.

Juicing for life?

I remember watching the 2010 documentary “Fat, Sick and Nearly Dead”  with a friend and was completely floored at the way in which the film’s narrator and creator, Joe Cross was able to reverse some pretty serious health issues solely through juicing. The juice fast he undertook (in somewhat dramatic fashion, since he did this while traveling the U.S. with a mini juicer and generator) lasted for 60 days and consisted of a mixture of fresh fruits and vegetables. He called his fast a REBOOT because his body could no longer run efficiently, being bogged down by all the toxins accumulated from years of a high fat, red meat laden diet, lack of exercise and large amounts of steroidal medications administered to him for an auto-immune condition he was suffering from. He absolutely consulted doctors and medical professionals before beginning this fast and was monitored throughout the process until its end. What the film demonstrated was how important nutrition is to overall health and well being. It also proposed how committing to such a program can turn into a habit your body will fall into rhythm with and actually crave.

This was not my first encounter with juicing. Back in early 2005, I met a woman who successfully beat breast cancer with the help of homeopathic remedies and juicing. At the time, I was in the early stages of recovery from anorexia and she presented a way in which I could cleanse and nurture my body without that feeling of fullness that so wreaked havoc with my head. I bought myself a generic brand juicing machine that same day and began extracting the contents of anything green and fruity I could get my hands on. The first thing I noticed was how good my skin looked, but once my therapist caught wind I was subsisting on juice alone, she put a stop to it. I could only juice if it was a supplement to a meal. Since I was still afraid of fullness, my mind said that was just way too much to ask of my insides, so I put the juicer away and forgot about it.

Now in a much healthier state of being, there is nothing wrong with supplementing my balanced diet with a little juice. In fact, many registered dieticians agree that if you are otherwise healthy, it is a great way to get your recommended amounts of fruits and vegetables. There are, however, people who cannot undergo a juice fast, which is why it is so important to consult with a physician if you are planning a REBOOT style program. Diabetics, people with nutritional deficiencies and those with kidney disease are some of whom could respond adversely to an all juice diet. Also, people undergoing chemotherapy are cautioned against it while in treatment. With respect to weight loss, it is safe to replace one meal a day, let’s say breakfast,with freshly extracted juice, so long as the rest of the diet is balanced. The boost of vitamins, minerals and antioxidants is a better source of energy than sugar and caffeine.

One week ago, I decided to say “good morning” to my body with freshly extracted juice. My parents had a juicer they had never touched and I wanted to finally put it to good use. Call it an experiment of sorts, but I wanted to see how my body would react to having this raw liquid be the first thing to hit my stomach. Normally, I drink a lot of water upon waking and have a coffee. On DAY 1, I pulverized celery, Gala apples, carrots and a little sprig of parsley into a 12 oz glass of energy. Immediately, I felt my taste buds coming to life; they literally tingled after ingesting the juice. During my workout a half hour later, I found that I needed very little rest between sets. My trainer joked, “What are you on today?” The power of the juice, my friend. I went through the rest of my day eating as I normally would, but for some reason, I felt that I could taste things a lot more acutely than before. Salt was saltier; sweet was sweeter – it was kind of amazing, actually.

Day 2 was a totally different story. I added beets to the mix. The entire rest of the day I was nauseated and overheated. My face was flushed and I wanted to lay down. Upon waking on Day 3, I realized that I was now constipated. I made beet, ginger and carrot juice that morning. As I proceeded with my day, I felt a tightness in my gut as if there was a gas bubble that was stuck there. Still nauseated and having those odd hot flashes, I decided to eat very lightly thinking that maybe I was coming down with something. Day 4 came and went without any elimination of my gastrointestinal tract and a whole lot of discomfort. I made apple and carrot sans beets and ginger since I had run out of them. Upon waking on Day 5, the tummy troubles were somewhat over. Things were now running smoothly again, but I still had a lingering feeling of tightness in my GI tract that made me uncomfortable. I decided to research juicing recipes to have some variety in my extractions and this was when I came across the reason for all the issues I had been experiencing with my morning juice regimen. Just like prescription medications, certain vegetables and fruit juices in their raw form have…. SIDE EFFECTS.

Before I get into the specifics, let me just note that fatigue, nausea, tummy troubles and constipation are all normal when undergoing a juice fast, partly because it is a shock to the system to ingest juice solely. The lack of fiber from ingesting raw juice can make you constipated, while also causing you gas because of all the minerals and enzymes reacting in the gut. What I did was use juice as a first meal of the day followed by balanced meals containing protein, carbohydrates and healthy fats. I did not eat anything with my juice and waited at least 30 minutes to an hour before eating afterwards.

Here are the possible “negative” side effects of some popular juicing produce in their raw form. Keep in mind that they all have vast nutritional benefits, but for some of us, like yours truly, there can be an unpleasant sensitivity. Read on…

BEETS

Turning poop and urine a reddish color is a normal side effect that those who may not know, may get freaked out by. In rare cases, it can tighten the vocal chords, making it hard to speak. Usually this will happen when ingesting plain beet juice. Also, ingesting plain beet juice can facilitate the creation of kidney stones if you already have a pre-disposition towards them. Beet juice is also known to cause fluctuations in body temperature (hot flashes, anyone?), nausea and some degree of gastrointestinal distress 🙂 It naturally drops blood pressure, so if you are already on the low side some fainting spells may befall you.

GINGER

Mild side effects include heartburn, diarrhea and upset stomach. Some women report having heavier periods after ingesting ginger because ginger can interfere with blood clotting. Anyone taking medication to slow blood clotting like Warfarin otherwise known as Coumadin, Plavix or regular over the counter aspirin and ibuprofen could risk serious interactions. Ginger also dramatically decreases blood sugar, so diabetics and hypoglycemic folk need to be careful. Lastly, ginger is also known to interact with medications for blood pressure and heart disease. Powerful stuff, that ginger.

CELERY

Large amounts of this green could make the uterus contract and cause miscarriage in pregnant women; therefore it should be avoided during pregnancy and nursing. It is also known to cause drowsiness, since it sedates the central nervous system. This is not especially good if you are taking sedatives or planning to have surgery that requires anesthesia. It is recommended to avoid ingesting celery 2 weeks prior to a surgery. It can also increase sensitivity to sunlight, making sunburn, blistering and rashes likely if one is exposed to the sun. Finally, since celery is a natural diuretic (i.e. reduces fluid retention) it taxes the kidneys, our natural fluid filters. If your kidneys are compromised or diseased, celery should be avoided.

CUCUMBERS

So long as its not Chinese Cucumber, your standard English, Mediteranean or pickling varieties have only one annoying possible side effect – flatulence. This is due to a compound that can provoke indigestion in some people.

SOURCES:

Natural Medicine’s Comprehensive Professional Database (c) Therapeutic Research Faculty, 2009

http://voices.yahoo.com/identifying-beet-juice-side-effects-juicing-7742716.html