Inactivity and Weight Gain

Every now and then I read a paper that restores a little bit of my faith in obesity research. Most of the papers I read in the field pay lip-service to the same tired old stories: thrifty genes; calories in, calories out; energy density; fat intake; gluttony and sloth. None of which make sense upon close examination. The "overweight is due to sloth" theory, in its many forms, is one of the most often repeated. The main evidence for it is that overweight people tend to move less than thin people, which seems to be true. Exercise also burns calories, which can come from fat.

It may sound counterintuitive, but how do we know that inactivity causes overweight and not the other way around? Gary Taubes asked this question in Good Calories, Bad Calories. In other words, isn't it possible that metabolic deregulation could cause both overweight and a reduced activity level? The answer is clearly yes. There are a number of hormones and other factors that influence activity level in animals and humans. For example, the "Zucker fatty" rat, a genetic model of severe leptin resistance, is obese and hypoactive (I wrote about it here). It's actually a remarkable facsimile of the metabolic syndrome. Since leptin resistance typically comes before insulin resistance and predicts the metabolic syndrome, modern humans may be going through a process similar to the Zucker rat.

Back to the paper. Dr. Nicholas Wareham and his group followed 393 healthy white men for 5.6 years. They took baseline measurements of body composition (weight, BMI and waist circumference) and activity level, and then measured the same things after 5.6 years. In a nutshell, here's what they found:

• Sedentary time associates with overweight at any given timepoint. This is consistent with other studies.
• Overweight at the beginning of the study predicted inactivity after 5.6 years.
  
• Inactivity at the beginning of the study was not associated with overweight at the end.

In other words, overweight predicts inactivity but inactivity does not predict overweight. With the usual caveat that these are just associations, this is not consistent with the idea that inactivity causes overweight. It is consistent with the idea that overweight causes inactivity, or they are both caused by something else.

I've pointed out before that the "we're fat because we exercise less" theory is probably incorrect. It's based on assumptions that fall apart on close examination. Exercise is healthy, but it's not the most effective way to achieve or maintain an optimal weight. The body compensates for the calories burned during exercise by a phenomenon known as "hunger". Certain obesity researchers have stubbornly tried to deny this, because it puts a kink in the "calories in, calories out" hypothesis, but anyone who has ever gotten out of their recliner knows it's true. I believe overweight is largely caused by diet composition. If that's the case, then changing diet composition is obviously going to be a more effective treatment than exercise, which doesn't address the root cause of the problem. This idea is supported by numerous diet intervention trials.

Meet Charvie: My New Puppy

I try to focus this blog on weight loss surgery. But you know? I'm human and here is a really cool thing. We have brought home a new puppy and he is a sweetheart bundle of love. The following is from my personal journal September 3:The lights of our dog kennel building have been dark for two years, one month and two days. At twilight, on July 31, 2006 I shut the door to the building, not long

Delicious Wine Reductions for Cool Autumn Nights

So we've had weight loss surgery and are happily losing weight with a restricted diet and the improved ability to exercise. But you know, we didn't have taste bud surgery! We still have taste buds that crave delicious foods - we just want the foods we eat to be satiating and good for us.Let me tell you a culinary secret - it's in the wine! I'm not talking about wine in the glass, I'm talking

A Few Numbers

I went to the doctor's office recently to get some tests done, so I could get a biochemical window into my health. Here's what came back:

• Fasting insulin: 2.3 uIU/mL
• Fasting glucose: 88 mg/dL
• HbA1c: 5.8%
• Total cholesterol: 252 mg/dL
• HDL: 111 mg/dL
• LDL (calculated): 131 mg/dL
• Triglycerides: 48 mg/dL

I was thinking about not posting this for privacy reasons, but I think I'm an interesting enough case study to make it worthwhile.

I'll start from the top. The fasting insulin value is excellent; 2.3 is so low it's outside the "reference range" that's typically encountered. I don't have a trace of hyperinsulinemia, which implies a high degree of insulin sensitivity. I won't be developing metabolic syndrome anytime soon. My fasting blood glucose looks good, not much to say there.

The HbA1c reading is higher than I was hoping/expecting. It's "normal", but on the high end of normal. That could imply mild glucose intolerance. Perhaps a result of years of slamming myself with white flour and sugar. The other possibility is that my blood cells turn over more slowly than usual, which would artificially inflate the HbA1c number. I may buy a glucose meter so I can monitor my post-meal glucose. I wish I had HbA1c data from healthy non-industrial populations with which to compare. 5.8% does associate with a slightly higher risk of heart attack than 5% and below.

The lipid panel looks good. My total cholesterol is on the high side, mostly due to my extremely high HDL. My RN wrote "This is the highest HDL (high density lipoprotein, or 'good cholesterol') I've seen in 22 yrs of clinical practice!!" My triglycerides are very low, which also associates with low CVD risk. My LDL is on the high side, but it's probably the "non-atherogenic large, fluffy" LDL, judging by my HDL, triglyceride and insulin numbers. My triglyceride:HDL ratio and LDL:HDL ratio imply a low risk. Overall, the lipid panel looks very good to my eye.

However, I don't put a lot of faith in the predictive value of blood lipids. The studies that established links between blood lipids and CVD were typically performed in people eating the standard American diet. They don't necessarily imply the same risk in people eating an atypical diet like myself. Case in point, the Kitavans.

Here's a brief overview of my lifestyle:

• Diet, in descending order of calories: added fats like butter, lard, coconut oil and olive oil. Starchy foods like root vegetables, winter squash, legumes and quinoa (latter two always soaked 12-24 hours). Meat, organs and fish, wild or pasture-raised. Pasture-raised eggs. Soaked raw almonds and toasted hazelnuts. Fresh and fermented vegetables. Cheese, yogurt and raw milk. Fruit. Unsweetened chocolate. I estimate my macronutrient intake to be roughly 50% fat, 37% carbohydrate and 13% protein.
  
• Exercise: I cycle commute 30 minutes a day, lift weights briefly 2-3 times a week, sprint once a week, and hike regularly.
• Meditation: several times a week.
• Sleep: 8.5 to 9 hours almost every night.
• Assorted hormesis: weekly 24-hour fast, exercise, cold water swims, sauna.
• Good friends, family, community, relaxation.
  

Here are a few things I'm taking from this:

• I eat a LOT of saturated fat, yet my risk of heart attack is probably very low.
  
• A diet high in saturated fat that includes carbohydrate is compatible with excellent insulin sensitivity, at least in the context of an otherwise good lifestyle.
• I should look into my post-meal blood sugar.
  

Hectic random musings

Lots have happened this week.

A round up...

We lost young Josh (I think I mentioned that before) and immediately advertised for a new housemate. We found one and Nicky has moved in. She is really nice. She is Korean and learning English at a school in the city. So every day is a delight for her as she tries something new - mainly in the food category, but everything English overwhelms her. She is so pleased to be able to stay in a 'typical English home'... Yeah! Laugh your heads off..that's right, typical. I think I would go for 'Crazy' or 'Bloody Mad' English family to be honest!

Anyhow, she is in, paid up and life is sweet on that score againthankfully as suddenly losing £320 a month overnight tends to put the willies up One!

Work - it's been fine, but I have noticed that I dread Wednesdays. This is because I have a family of acute nerds who in my opinion should:
a.) get personalities
b.) get social skills
c.) get some furniture (instead of having one small sofa and a massive Yamaha ONLY in a 25 x 14ft room!)
d.) get personalities
e.) and other stuff!

So, it was obviously with deep joy that yesterday rolled around after having a most beautiful 6 week rest from what must be the most inane geeky family in the world.

It had actually got mildly more bearable about a month before the holidays, when the mother of said geek family, actually stopped her lessons because she had too much work on. So, when I arrived at their empty chasm of an abode yesterday, I was thrilled when she told me she was starting again. Frankly, I would've liked to have known that I had to sqeeze an extra half hour into my schedule before hand, but there we go. So I smiled sweetly and thought of the fat cheque.

To be honest, the lesson actually went well, because I was dreading it. Yesterday morning, I sat down with DH and we had a massive chat about it. I was all for slinging in the towel (as I did not know that Mother wanted to kick start again!), but he said that maybe I should just regain control by putting them a little bit out of their comfort zones. Hmmm thinks I. This could work. I actually felt really good when I told each one, turn after happy turn, that we would be doing something different and not just sticking to the stuff they liked/was easy for them. It went surprisingly well.

When I feel in control, I feel ok about my job, but some of the upstarts I teach like to tell ME how it is. Obviously I have only been doing this for 13 Years... what do I know right? Anyway, long story short, yesterday was full of little mini victories for me. So I will endeavour to focus on the whole pay cheque thing, and just teach them, and not try not to groan outwardly when I sit for 2 hours on a hard stool and teach 4 people who have no opinion, or spark, or conversation, or passion for what they are learning and indeed paying for.

Also, yesterday my Dad had his reversal operation. He was diagnosed with bowel cancer back in the spring, remember? Well yesterday he had his colostomy bag reversed, and yesterday evening was sitting up in bed eating tomato and cheese sandwiches and ice cream with a big white bandage over the bit where the stoma has been these last 6 months. He is delighted. I have no idea when he gets out of hospital, but its not the big operation like it was last time thank goodness.

So, foodwise and bandwise...
Dunno. I have been sick a couple of times this week. I have been pretty good with my eating, no crap like crisps or biscuits or wine...
trying to remember my food for the week is hard. Yesterday I made ratatouille and rice for lunch, and in then evening we had fish and chips. I had 1/4 piece of cod, 6 chips, 1/2 sausage and 1/2 fish cake. I was actually full about 10 mins into the meal, but it was so yummy I cheated a little and followed every mouthful with a little sip of orange juice so that it made it wetter and would slip down. I know that's REALLY naughty, and I wont do it again, but it proves to me that I have restriction, and more than I did before Sunday's fill! I think I do have the restriction just about right now. I am gonna try and stop freaking that I haven't, because I honestly think I am about right. I am still 0.2ml below my highest fill level, so I think this could be about it, as I don't want to go back to where I was before!

After yesterdays dinner I felt horrid. I felt really bloated and awful. I lay in bed and I actually had tummy pain like I needed an alka seltzer, so that kind of food is just not doing it for me. So its back to meat and 3 veg again. I am not even going shopping tomorrow because I physically cannot get anything more in my cupboards or freezer. Its got to the point where I am going to the supermarket out of habit rather than necessity, so I am going to make what I can out of what we have for a week or so.

Tuesday! I remember now, I made purple sprouting soup followed by roast duck and green vegetables. I was sick after this meal.

Today, I don't know. it will have to be an oven job because of the schedule for today, and everyone will eat much earlier than me. I think I will make a quiche and salad. Easy peasy, and they can serve themselves then.

So that's just about it. I am taking Steven to the vet in half an hour to get his mini pom poms removed as he has taken to peeing on beds and washing and starting all that territorial 'Man Cat' rubbish. Hes a little young, but I just cant have cat pee on beds. NO NO NO.

My scales have run out of battery so I have no idea how I am doing since Sunday, and I am not going to worry until Sunday to get a good reading, so there we go. Over and out.

Post Script
After reading through this to check for errors, it has flagged up to me that I keep trying to PROVE the band. This has lead to my dawning realisation that if I keep trying to prove the band, I am over eating and therefore not going to lose weight. I can PROVE the band is ok by just eating normally and seeing the weight drop off. I have no idea why this hasn't dawned on me before, but now it has.

Resolution: I am gonna eat normally and prove my restriction is right by my weight loss, rather than keep eating until I feel I need to be sick. That's just plain madness!

A Practical Approach to Omega Fats

Hunter-gatherers and healthy non-industrial cultures didn't know what omega-6 and omega-3 fats were. They didn't balance nutrients precisely; they stayed healthy by eating foods that they knew were available and nourishing. Therefore, I don't think it's necessary to bean count omega fats, and I don't think there's likely to be a single ideal ratio of n-6 to n-3. However, I do think there's evidence for an optimal range. To find out what it is, let's look at what's been done by healthy cultures in the past:

• Hunter-gatherers living mostly on land animals: 2:1
• Pacific islanders getting most of their fat from coconut and fish: 1:2 or less
• Inuit and other Pacific coast Americans: 1:4 or less
• Dairy-based cultures: 1:1
• Cultures eating fish and grains: 1:2 or less

It looks like a healthy ratio is between 2:1 and 1:4 n-6 to n-3. Some of these cultures ate a good amount of n-3 polyunsaturated fat, but none of them ate much n-6. There are three basic patterns that I've seen: 1) low fat with low total n-6 and n-3, and a ratio of less than 2:1; 2) high fat with low total n-6 and n-3 and a ratio of 2:1 or less; 3) high fat with low n-6 and high n-3, and a low carbohydrate intake.

I think there's a simple way to interpret all this. Number one, don't eat vegetable oils high in n-6 fats. They are mostly industrial creations that have never supported human health. Number two, find a source of n-3 fats that can approximately balance your n-6 intake. In practical terms, this means minimizing sources of n-6 and eating modest amounts of n-3 to balance it. Some foods are naturally balanced, such as grass-fed dairy and pastured lamb. Others, like coconut oil, have so little n-6 it doesn't take much n-3 to create a proper balance.

Animal sources of n-3 are the best because they provide pre-formed long-chain fats like DHA, which some people have difficulty producing themselves. I don't trust flax because paleolithic humans wouldn't have eaten anything like it, and it's full of phytoestrogens. Fish oil and cod liver oil can be a convenient source of n-3; take them in doses of one teaspoon or less. As usual, whole foods are probably better than isolated oils. Weston Price noted that cultures throughout the world went to great lengths to obtain fresh and dried marine foods. Choose shellfish and wild fish that are low on the food chain so they aren't excessively polluted.

I don't think adding gobs of fish oil on top of the standard American diet to correct a poor n-6:n-3 ratio is optimal. It may be better than no fish oil, but it's probably not the best approach. I just read a study, hot off the presses, that examines this very issue in young pigs. Pigs are similar to humans in many ways, including aspects of their fat metabolism. They were fed three diets: a "deficient" diet containing some n-6 but very little n-3; a "contemporary" diet containing a lot of n-6 and some n-3; an "evolutionary" diet containing a modest, balanced amount of n-6 and n-3; and a "supplemented" diet, which is the contemporary diet plus DHA and arachidonic acid (AA).

Using the evolutionary diet as a benchmark, none of the other diets were able to achieve the same fatty acid profile in the young pigs' brains, blood, liver or heart. They also showed that neurons in culture require DHA for proper development, and excess n-6 interferes with the process.

With that said, here are a few graphs of the proportion of n-6 in common foods. These numbers all come from nutrition data. They reflect the percentage n-6 out of the total fat content. First, animal fats:


Except salmon oil, these are traditional fats suitable for cooking. Except schmaltz (chicken fat), they are relatively low in n-6. Next, vegetable oils:


These range from very low in n-6 to very high. Most of the modern, industrially processed oils are on the right, while most traditional oils are on the left. I don't recommend using anything to the right of olive oil on a regular basis. "HO" sunflower oil is high-oleic, which mealns it has been bred for a high monounsaturated fat content at the expense of n-6. Here are the meats and eggs:

n-3 eggs are from hens fed flax or seaweed, while the other bar refers to conventional eggs.

A few of these foods are good sources of n-3. At the top of the list is fish oil, followed by n-3 eggs, grass-fed butter, and the fat of grass-fed ruminants. It is possible to keep a good balance without seafood, it just requires keeping n-6 fats to an absolute minimum. It's also possible to overdo n-3 fats. The traditional Inuit, despite their excellent health overall, did not clot well. They commonly developed nosebleeds that would last for three days, for example. This is thought to be due to the effect of n-3 on blood clotting. But keep in mind that their n-3 intake was so high it would be difficult to achieve today without drinking wine glasses full of fish oil.

Freezing

Its so cold in this house. My fingertips are blue.

Yesterday I went for another fill. I had 0.3mls put in. This takes me to 6.3ml in my band.

I cant say that I feel a whole lot different, but I am not sure...

This is such a surreal thing. I know what 'way to tight' feels like. I know what 'oh so slack' feels like. What I have now is I think different to a few days ago... but I'm not sure.

Hmmm. I will monitor it for a few days and see.

Today's intake:
Breakfast
1 wholemeal pitta with cheese and onion sandwich filler
Lunch
1 bowl tomato soup and 2 slices bread and butter
Dinner
spaghetti carbonara and a green salad.
Snack
Vanilla fromage frais.

I have not been hungry between meals. I feel full and satisfied, but able to complete my meal. I have not been sick.

Hopefully this is it. I am slightly panicky that my band is broken... not because I actually think it is, but because in some strange sense I felt that when I was choking on every meal at least I knew the band was there, whereas now I am eating, albeit gingerly, adequate amounts. I am worried that something will go wrong, I guess because I have put on weight. I have put on 8 pounds in the last 4 weeks. 2 pounds a week since I had my really restrictive fill taken out. That's stressed me out a hell of a lot.

I just hope being back to work, coupled with 0.3ml will sort me out for a while. I don't think I can face another drive to London this month!