Saturday, February 20, 2010

Energy Balance and Weight Loss

The law of thermodynamics states that there is no free energy. Energy in equals energy out! All this is to say that if one consumes less energy (measured in calories)than is burned that a person will loose weight. But to do that some may have to eat like a bird and work like a horse. Others can eat like a horse and work like a bird and still lose weight. The difference is in the metabolic rate and lifesyle, not excercise. As mentioned on last week's blog, caloric burn can easily be measured on the $50 test called a RESTING MEATABOLIC RATE (RMR). The burn is determined by Exercise, Lifestyle Activity and RMR and the supply is determined by food consumption-what we eat. Although all calories consumed are not the same, but this is a topic for another blog, but for now let us assume they are.

Exercise, although healthy, burns a surprising little energy. Three hundred calories for an hour of very strenuous workout is about all one can get out of it-an extra candy bar a day. However, Life Style Activity is just moving through one's daily doings and can be greatly modified. An increase of simple activities such as never using an elevator, parking two blocks from work, walking up and down your house stairs twice instead of the once that you would ordinarily do and the technique of dynamic tension will double your caloric outgo in this equation of health.

Dynamic tension is working two opposing muscle groups against each other with out moving the limbs to which they are attached. Pushing your palms together as hard as possible or “making the biceps muscle” hard are examples. This can be done many times a day at times of wait like at red lights, standing in line, while talking or waiting for the party to answer the phone. This will loose fat in two ways. One, by burning extra calories by using these and two, building muscle. For every pound of muscle one makes, it takes a hundred calories a day to service and maintain it. Not only that but it will decrease one's anxiety during the delay which is interpreted as stress by many type A personalities and produces harmful free radicals and fat-gaining cortisol. It is said that Charles Atlas, the body builder of the 1950’s kept his body in good muscular form and in prime health by this method.

Again one's exercise must include heavy resistant (weight) training to build muscle that will translate into raising the RMR and loss of fat. Other ways to increase the RMR is by supplements as mentioned last week. Medically, hormones are adjusted by giving that which is missing, not so much by its decrease in the blood, but with the natural down regulating of insulin, thyroid, and testosterone receptors. Aging, free radicals and organic disrupters like Biphenol A found in most plastics Pthalates that leached into our water supply from modern farming is only now catching the eye of government concern. Lipotropics such as methionine, choline, inositol and HcG do this as well as giving more of the necessary hormone particularly thyroid despite normal blood tests. As noted on last week's blog, medical doctors are finially recognizing that low thyroid does exist despite normal blood tests. This is Type II hypothyroid and is diagnosed today as it was 75 years ago by the RMR.

So if one is “dieting” and it is not working or eating the same foods and now gaining fat, consider the above. Dieting is not an answer to the problem but a short term fix until lifestyle will prevail.. That is why in a large study done recently 94% of those that lost significant weight dieting found it within the ensuing two years. With the help of the RMR, your health care worker can not only guide you into achieving your weight goal which is not too difficult, but keeping it there for the rest of your life.

Tuesday, February 16, 2010

BMR - An Underused But Vital Medical Test

Basal metabolic rate (BMR), and the resting metabolic rate (RMR) are medical tests used extensively in the last century but has been all but forgotten by modern medicine. However they are still important in this era despite the marked advance of other technology. These are useful in many nutritional problems but it is particularly helpful in weight loss and thyroid disease. They cost $50, take 15 minutes and are done in the doctors office These measurements are the amount of energy used resting after fasting done at room temperature.. The release of energy in this state is sufficient only for the functioning of the vital organs, such as the heart, brain and liver. They decrease with age and loss of muscle and altered by hormones, drugs and diseases.

Cardiovascular fitness has been shown in the 1990s not to correlate with BMR and RMR, when fat-free body mass was adjusted. New research has shown aerobic exercise does not increase resting energy consumption. But stress levels can. BMR and RMR are measured by gas analysis through by direct calorimetry with devices such as the Reevue but a poor estimation can be acquired through an equations using age, sex, height, and weight.

Whether we gain or loose weight is dependent on our food consumption and energy expenditure. About 70% of a human's total energy outlay is due to the basal life processes of our vital organs. About 20% of one's energy expense comes from physical activity and another 10% from digestive and caloric heat processes. These mechanisms are referred to as Thermogenesis which comes from shivering and the volume of innate and genetic brown fat endowed to the individual. Life requires an intake of oxygen along with coenzymes (vitamins and minerals) to metabolize food. Anaerobic such as resistance training, but not aerobic builds additional muscle mass, which is fat free mass. Additional fat free mass will lead to a higher resting metabolic rate.

The regular Aerobic exercise is beneficial for cardiovascular reasons as well as direct calorie burning. Recent studies indicate that heavy endurance exercise increases resting metabolism. But light cardiovascular training has not the same effect. Continuous moderate exercise such as jogging or doing many light weight repetitions does consume calories, but not an “after burn”. On the other hand Aerobic Interval Training (AIT) or Progressively Accelerated Cardiovascular Exercise (PACE) not only consumed calories but also gives a significant after burn by increasing the BMR and RMR for 72 hours. This is why I recommend Burst Training (pushing to temporary respiratory fatigue)when doing aerobics. For example, when jogging, periodically run so fast that one is unable to do more than a minute because of extreme shortness of breath. This pushes past the aerobic state into an anaerobic one with an oxygen debt! This then resets the metabolic rate to a higher level. Doing a RMR/BMR not only predicts who will be overweight (obesity), but what how much one needs to do to loose that fat. For example there are ways to increase thermogenesis such as cosumption of bitter orange, ginger, capacisin, ephedra, guarana, and caffeine.

BMR/RMR is very helpful in diagnosing thyroid disease. In an overactive thyroid it is high and low in hypothyroidism, which has several varieties. A Secondary in which the pituitary is at fault and two Primaries which are Type I Hypothyroidism in which there is suboptimal Thyroxin production, but even more common is the Type II in which there is enough Thyroid Hormone, but the cellular receptors are blunted. The cell is less metabolically active despite adequate amounts of Thyroxin in the blood. With Type I the T4, and T3 are low and the Pituitary tries to stimulate the Thyroid by making more TSH that therefore is higher than normal. With Type II like in Type II Diabetes in which there is enough insulin but the cells are resistant to the effects of the hormone all these blood tests are normal. It is almost impossible to diagnose Type II Hypothyroidism for certain and to properly treat it without these test of metabolism, the BMR/RMR. In this day and age when we ingest so many hormone receptor disrupters in our pollutants (pesticides, plastic molecules etc) in our food and drink, no wonder why we are having an epidemic of Type II Hypothyroid that we physicians ignore. If you are having trouble losing weight or have symptoms of low thyroid such as fatigue, cold intolerance and yet have normal thyroid tests, get a RMR. You deserve to be fixed.

Sunday, February 7, 2010


The American Diabetes Association has recently endorsed the new criteria of Hemoglobin A1c (Hgb A1c) of 6.5% or greater to make the diagnosis of Diabetes 1 or 2. This blood test which has been around for 20 years is now highly standardized, and commonly preformed in physician's office with a pin prick of blood. The Hgb A1c is a reflection of the last 3 months of sugars. If the sugar was 100 all the time it would be 4.5. The higher the sugars, the higher the number and the worse outlook for the patient. The older standard of a fasting blood sugar of greater than 126 or a 2 hour after eating level greater than 200 (or 2 hours after 75 gms glucose), in a patient with classic high blood sugar symptoms, a random blood sugar of the same 200 makes the diagnosis of diabetes.

Many known diabetics test their fasting blood sugars. This is in error in that this is usually the lowest blood sugar of the day, after all night fast and gives the patient a false sense that their diabetes is doing well. Let them do it 2 hours after a meal particularly a high carbohydrate one and it will give a more accurate status of the diabetes. The only time a fasting blood sugar helps is when one suspects a low level.

Most doctors would be happy if the A1c would be 7% or less. Not this doc. I want it under 6! Studies have shown, the closer the sugar is kept to 100, the less complications from the diabetes will occur. However, if very tight control is sought and the patient is taking sugar lowering medicines, the possibility of too low a sugar (hypoglycemia) could happen with dire and even lethal consequences. Levels above 8 % are associated with a significant all-cause mortality risk.

The doctor and you should know that anemia causes a false lowering of the A1c. Also older folks have a higher levels than younger people, and blacks have higher levels than whites for any given level of sugar. Nine percent of the population are “high glycators” or “low glycators” and give a falsly high or low reading in these cases This can be easily determined over the next several months with blood sugars or immediately with another similar test, a fructosamine.

The Metabolic Syndrome, a more malignant form of prediabetes or “increase risk for diabetes” is a level of Hgb A1c of 5.7. This corresponds to a fasting blood sugar between 100 and 125 or a 2 hour after eating height of greater than 140. This syndrome has in common with diabetes ear creases and the morbid complicators of diabetes. These are increased triglycerides, blood pressure, abdominal girth and a low HDL (healthy/good) cholesterol. In particular that individual has a 7 times higher incidence of having a cardiovascular event in the next 5 years than a person of the same age and sex without these gruesome characteristics!!

Friday, February 5, 2010


The brain uses mainly glucose for its fuel, but works far better when fed ketones. Ketogenic diets have been used in medicine since 1924 initially to prevent seizures, and recently to treat degenerative neurologic diseases such as Multiple Sclerosis, ALS, Strokes, and Dementia. Thirty years ago, Medium Chain Triglycerides were found to be metabolized into ketones by the liver. No longer did one have to eat the very stringent ketogenic diet, which was 70% fat 25% protein and only 5% carbs. A person could ingest a given amount of MCTs and produce their own ketones. The ketones do supply cerebral energy metabolism (provide alternative fuel), protect cerebral function, suppress cerebral edema and reduce the extent of cerebral infarction in brain injury.

The presence of ketone in circulation, even at low levels, increases cerebral blood flow by as much as 40%. Ketones also prevent diseases involving free radical damage such as occurs in coronary reperfusion, diabetic small blood vessel disease, inflammatory bowel disease, and pancreatitis. MCTs do not behave like the more common long chain fats. Because of their shorter structure, they are metabolized directly in the liver into ketones, rather than going into storage in fat cells. They are used as an alternative source of energy when glucose stores are exhausted.
Two years ago a drug company applied for and received a patent to bring this out as a prescriptive functional medical food. The Acerra Company brought out Axona® to treat Alzheimers disease.

The neurons work 30% better using ketones rather than the usual glucose. It is like putting high-test gas in an old high compression engine, it runs much better without the "pings". In a review article on Alzheimers in this week New England Journal of Medicine, the metabolism of the brain cell was detailed as "Type 3 Diabetes" in which the glucose receptors were blunted and could not transport the sugar into the brain cell to produce ATP, for cellular energy. Not only could the cell take in the ketone, but more efficiently made ATP (energy) from it. MCTs have been medically used in the past for feeding premature infants, recovering surgical patients and for malnutrition. Off label it has been used for liver support, antimicrobial therapy, enhancing the immune system and to increase athletic performance. Contrary to popular opinion these tropical saturate fatty acids inhibit atherosclerosis instead of producing it. They also decrease appetite and help people lose weight much like the ketoses of Atkins diet. Also there is not a tendency for diabetics to have problems of "diabetic coma", keto-acidosis with MCTs.

Coconut oil, which is a misnomer, in that it is solid at room temperature contains over 60% MCTs. Not only is this a healthy cooking oil in that it has a high smoke point, but it has a pleasant taste. It can be used in baking, oatmeal, spreads and salad dressings. Costing $8 for 14 oz for organic and $5 for the regular it is almost a best buy for this cooking oil that doesn't smoke unless the temperature exceeds 280 degrees. Butter smokes/burns at a much lower temperature producing free radicals that rust our body. Research at NIH by Richard Veech, MD. indicates that ketones which are made from coconut oil and MCTs work better since a higher dose is more easily achieved. However, they are not yet available.
To treat Alzheimers today and give that high of a dose of MCTs (20 grams per meal), you need to combine 16 oz. of MCT oil with 12 oz. of coconut oil and use 7 teaspoons at a time. It should be stored at room temperature, and increased gradually from 2 teaspoon per meal up to 7 teaspoons. Given too much at a time initially will cause abdominal cramps and diarrhea.

Although costing twice as much, one can use Axona® which may be paid by some insurances and for sure by flex plans. It has a pleasant coconut taste when used as a cold drink with a meal. There are no omegas 3s in this mixture, therefore I recommend some fish or fish oil during the day because this compliments the MCTs for improved brain function. Several varieties of Alzheimers and the APOE negative types respond better to this therapy. Since the brain starts developing defects in glucose metabolism decades before the development of the disease, those who have a strong family history, or memory problems earlier in life might consider doing this treatment now!