Stop The Weight Loss Madness

This past week, I saw no less than ten patients who wanted to lose weight. Each described in their own unique way how the extra weight was contributing to some perceived problem they had with the weight's effect on their image, energy level, health, etc.

To each patient, I said the same thing. Stop focusing on losing weight and start focusing on what you can and cannot do to your body to help it function at its optimal level.  To each, I conveyed how the human body was developed over millions of years, with its most latest form, homo sapiens being around two hundred thousand years old. Over this period of time, human biology has evolved a full host of protective mechanisms to ward off disease. Of course, we all know these mechanisms sometimes fail miserably. It is very unfortunate when it does, and my heart goes out to those who suffer seemingly happenstance illness. Nevertheless, these mechanisms work for most and that is why the human body can usually protect itself fairly well against poor eating, lack of exercise, inadequate sleep, mounting stress, etc. for at least the first five or six decades of life.  It's not that damage isn't being done, it's just that the damage isn't always so obvious until later.

I often share with patients the story of the my growing up in Brooklyn, NY and how one day the red lights turned on in on the dashboard of my father's old car.  I share how my father drove it to a nearby gas station and spoke to the attendant and asked if he could help with the red light, to which he replied, "yes, I can disconnect it."  Now even to a young boy that was a ridiculous statement. Little did I realize that during medical school and my residency, my teachers and mentors would primarily educate me on how to turn off patients' red lights. As doctors have become successful in eliminating symptoms without addressing the underlying problem, akin to turning off a red light warning of problems, patients have been confused into thinking they don't really have a problem. A case in point is a patient this week telling me that he was very healthy with normal blood sugar despite the fact that he was a diabetic on high blood sugar medication and nearly morbidly obese.

For some reason, Americans seem to disassociate the reasons they gained the weight with the effects such reasons have on their health beyond the number on a weight scale.  They gain weight because they ate too much, they ate the wrong food, they barely moved, they slept poorly and were always hungry, etc. That is why I tell people to stop worrying about the numbers on the scale and to start paying close attention to the details of their lives. Although there is no perfect plan for staying healthy as the old Yiddish saying goes, mensch tracht un Got laft, men plan and G-d laughs, it still pays to plan. Therefore, by focusing on those elements of your life that you do have control over, you can shift the odds of staying and getting healthy in your favor. By doing so, one of the benefits is usually weight loss.

I have always believed that for virtually all problems, there are solutions.  Over the past three years, by investing the time and listening carefully to what patients are telling me, in partnership with them, I have helped them identify such problems and come up with workable solutions.  It has been a three year whirlwind and I am so grateful that I had the opportunity to so positively effect so many lives.  However, as clinically successful and emotionally rewarding this endeavor has been, the time has come for me to move on to my next challenge. I will always be grateful for all that my patients have taught me and the wonderful personal stories they shared.

I know that those who embraced my philosophy about taking care of the one body they had by eating healthy foods in moderation, avoiding unhealthy foods altogether to the extent possible, physically staying  active over the course of a day as much as possible beyond simply going to a gym for a specified work-out, improving sleeping habits, managing stress more effectively with good meditation and relaxation techniques, nurturing relationships and being grateful for the good things in life, have and will continue to reap great benefits from developing such good health habits.

To the rest of you I say, while good health is never guaranteed, a healthy lifestyle can shift the odds in your favor. Choices do have consequences so please choose wisely. Stop chasing weight loss like a lost puppy and focus on what really matters--your overall well-being.

If You Jump Up and Down After Reading Today's Blog, You May Actually Remember It When You Get Older!

It won't come as news to anyone that exercise helps you stay fit and being fit is good for your health. It also probably won't come as a surprise that being fit is good for your mood. But what about memory? Will exercise preserve memory? Does being fit earlier in life affect what happens many years later? Will being fit prevent Alzheimer's and other forms of dementia?

Until now, scientists have had strong suspicions that lifestyle plays a meaningful role in preserving healthy brain function, but they didn't know for sure. A new study just came along that moves the needle along in validating the key role that exercise plays in prevention.

Published in the February 5, 2013 issue of the Annals of Internal Medicine, the study titled "The Association Between Midlife Cardiorespiratory Fitness Levels and Later Life Dementia" was a cohort study that does not prove cause and effect but deserves close attention. The study performed at The Cooper Institute in Dallas Texas involved 19, 458 middle aged people who had a treadmill exercise test as part of health care preventive visit. Based on the amount of time that a person was able to run on the treadmill, researchers grouped them into two categories of most fit and least fit. They then followed these people for many years, beyond the time they reached 65 years, to see who developed dementia.

What did they find? You guessed it. The people in the most fit group were far less likely to develop dementia. Although the study did not look at diet, which is obviously an important contributing factor to health, and was limited to mostly healthy white people, it does offer possible evidence of an association between fitness and memory preservation.  Again, the study did not prove cause and effect but it does provide yet another reason to stay fit by being physically active.


While only 1 out of 8 Americans develop dementia by the age of 65, that number rises to 3 out of 7 by age 85. Although that represents less than half of those over the age of 85, no one, but the most cynical, would disagree that it would be better to avoid dementia than experience it.  It's no fun to lose your memory. Just ask anyone who suffers from a form of dementia or watched a loved one die from it. The good news is that science suggests that if you get to age 90 without developing dementia, the probability of development appears to decrease due to possible suppression of the gene responsible for it.

So if you are sitting down when you read this, it may be a good idea to get off your seat and jump up and down.  If you keep doing that long enough and as often as possible, you may remember this blog for many years to come. That would be nice, right?

Nu? So what are you waiting for? Get up and get moving! Now, before you forget how important it is to your future memory...

Government Reports Extra Weight May Be Healthy. Really?

Is anyone else shaking their heads in disbelief over the new government study that shows that people who are overweight are less likely to die in any given period than people of normal weight?  This study was based on a review of 97 other studies.

First of all, many are calling the study proof of the "Obesity paradox," although the study clearly showed that obese people, that's people with a BMI above 30, had an overall increased risk of dying. Also this was an observational study, not a cause and effect one, which already makes the results somewhat questionable.

Second, if 67% or so of the population is overweight and 36% is obese, which means that 31% are overweight and not obese, that only leaves 33% of the population as either normal weight or underweight.  Included in the 33% are people who have lost weight due to illnesses such as cancer, eating disorders, hyperthyroidism, malnutrition, etc.

The study does not account for why people fall into the normal and underweight category (healthy or unhealthy lower weight) given the preponderance of people in the overweight category.

Third, it doesn't account for people who have normal BMIs, but high waist to hip ratios which signifies excess white fat, the dangerous kind of fat. A recent Mayo Clinic study showed  that among 14,000 study subjects, those with a normal BMI, but a high waist-to-hip ratio, were the most likely to die of heart-related disease during the 14-year follow up, even at higher rates than those in obese ranges.

Fourth, it is well established that people in advanced stages of cancer and diabetes do better with additional weight because as the body wastes away, it takes longer to do so. G-d forbid you should need excess weight for that reason.

Fifth, the study did not assess people who were underweight as it is known that such people have increased mortality. The underweight people were lumped together with the normal weight people to come up with a total death rate, so one can expect that the underweight inclusions skewed the numbers somewhat.

Sixth, the study did not address people who are overweight on the road to becoming obese, as opposed to those who are chronically overweight. By not knowing if recent illness is contributing to change in weight, we can't do an apples to apples comparison.

Seventh, the study underscores why BMI may not be the most reliable indicator of unhealthy weight because it does not take into account the muscle to fat ratio. Athletes, for example, could have increased muscle mass that will increase their BMI and put them into the overweight (even sometimes obese) category despite their otherwise good health.

Eighth, it is well know that excess weight, in and of itself, does not mean you are unhealthy if you don't have concomitant increases in cholesterol, blood pressure or blood sugar.

Ninth, is there a difference between a BMI of 25.1, which puts you into the overweight category and 29.9, which keeps you out of the obesity category? The study does not address gradations of being overweight.

Tenth, and finally, it not entirely clear to me what exactly is the point of this study. Is it to tell people that being overweight is not as bad as most people think? Should people who are overweight, but not obese be less concerned about their diet and lifestyle?

Of greatest concern, should people who are overweight, but not obese, make sure that they don't lose any weight as that may increase their risks for death?

I am not surprised that this is a government study as I find such studies to sometimes be the most generically misleading. Such a study would seem to offer comfort to the 67% of Americans who find themselves in the overweight category as you can rest assured that most people will not even bother to look past the headline that states that extra weight may be healthy. They will just take comfort in the notion that that extra piece of bread or serving of pasta may be health promoting.

G-d help us all if the government keeps doing these types of studies. Next thing we know they will tell us to cut out fats and eat more carbs. Oops, they did that already and we all know what happened.

Update, February 3, 2913:  A recent study offers support for the notion that far more important than BMI is the waist to hip ratio. This measurement of "belly fat" is more indicative of overall health because the build-up of white fat cells at one's midsection is more reflective of overall inflammation within blood vessels and risks for heart disease.  So those who took heart from the study that it's better to be heavier than be normal weight, please understand that this referred to well distributed weight and not weight concentrated around your gut.

It's Never One Thing

It would be an understatement to state that I have become fascinated with all aspects of longevity and disease prevention. Over twenty thousand studies and a dozen books later, my search for the quintessential answer to a long and healthy life goes on.  The body of knowledge is so vast and the hours are so short that I suspect that I shall never fully grasp all the intricacies of what allows any single person to optimize his or her longevity and minimize susceptibility to disease. While scrutinizing certain cultures that appear more successful at longevity may offer some clues, even among their members you will find those that die far younger than others despite similar lifestyles.

However, one thing has become abundantly clear to me: a long and disease free life is never dependent on just one thing.

This statement is made with the caveat that obvious detriments to health, such as consuming lethal poison or jumping off a perilous cliff, offer certain consequences.  Nevertheless, when one removes from the list such immediate threats to continued living, it becomes crystal clear that a host of factors contribute to the life we live and the day we die.

Foremost, but often not close to the most important factor, is the role that genetics plays. This is the influence least under our control as we obviously have no role in choosing our parents. But numerous studies, and in particular, the Swedish Twin Studies (that began in the 1870's, involving tens of thousands of identical twins who happened to grow up separately with varying lifestyles who developed different diseases and died at vastly different ages),  have demonstrated that genetics plays no more than a 15 to 30% role in our overall longevity and disease development. Of course, those born with Down's syndrome, hemophilia and other genetic disorders would argue otherwise and they would be right. But for most people, genetics at most represents a predisposition for diseases whose ultimate manifestations are under our control.

So what does matter? For one, but not alone, it is environmental factors. Which? That's the $64,000 question. Is it processed foods, gluten, pesticides, household chemicals, pollution, contamination, etc., or could it be some mix and match of all of them?

Anyone who tells you they know with certainty is either delusional or just flubbing.

The reason no one can tell you the absolute answer is that it is often different for different people. For example, there are smokers who live to 100 and others that die far earlier. Some obese individuals have heart attacks in his or her 30's while others survive into their 90's.

More importantly, no one can do better than hypothesize because the scientific method can never be applied to such a multivariate question. The gold standard of scientific inquiry into a population's health would require a double-blind, randomized controlled study where all confounding variables are controlled. Unless we could snugly place people in a bubble, we could never firmly establish a definitive working conclusion.

Nevertheless, scientists slog on trying to make sense of what they can. They can show a strong correlation between smoking and lung cancer, alcoholism and cirrhosis of the liver, obesity and heart disease, etc. What they can't do is tell you if you simply avoid or consume one particular food then your longevity is guaranteed to be positively or negatively impacted, respectively.

For example, I think there is a strong basis in science to call sugar a human poison, albeit a slow acting one. My patients are cautioned to avoid it and to go to great lengths to minimize their exposure to it. Nevertheless, I don't believe that avoiding sugar alone guarantees a long life.

I often tell my audiences that if they eat plenty of fruits and vegetables, nuts and beans and seeds, whole grains and wild fish--they are going to die.  I suspect they expect a different conclusion than the one proffered, but it's the truth.  Long before processed foods even existed, people died and some at relatively young ages from a myriad of other factors--infections foremost among them.  Food allows you to live by providing essential nutrition, but it doesn't guarantee health. Healthy eating doesn't offer protection against many simple infections like chickenpox and viruses or more esoteric infections like tuberculosis and tetanus.  These sometimes life-threatening ailments often depend on passing exposure to these pathogens.

So what else matters? The mind.

Many an otherwise healthy person has been befallen by stress, anxiety, depression or any other number of mental health issues. Such factors may have a genetic or familial disposition. Some may be purely situational. Sometimes it's both. The connection between the mind and body is well established. It facilitates innocuous placebos to work and allows real, measurable systemic diseases to develop in the absence of any other factors.

I have witnessed this first hand. Learning about my family member's cancer brought back my heartburn which I thought I had banished forever. No diagnostic medical test, and I've had plenty of them searching for a clinical reason, has shown any other identifiable cause for this phenomenon. I know it is because of stress.  Despite eating, sleeping, and living well, I have struggled to control my own guttural reaction to difficult news. I know that I must learn to manage my reaction to difficult news and I strive everyday to naturally manage my stress to relieve my symptoms.

This is why I know that the complex human body forged over 150,000 years to it's current form, and millions of years earlier in prior forms, is at once and always will be a very vulnerable and fragile system, highly complicated and efficient-- a veritable miracle of nature subject to forces sometimes beyond our control.

Although many would have you believe by the titles of their books such as "Why We Get Fat" or "Wheat Belly" that your health depends on one thing, I will tell you that it's simply not true.  No pill, prescription or supplement, no food described as super or otherwise, no exercise routine, done in the gym or in nature, will guarantee health.  Alternatively, certain vices like smoking and excess alcohol, consumption of certain processed foods, a sedentary lifestyle, poor sleep, great stress, etc. while expected to have a detrimental effect on your health, don't always factor in your death.

Your health depends on a combination of factors that affect both your body and mind.  Ignoring any of these factors shifts the odds against you for a long and healthy life.

But please take note, it's never one thing.

Do Fruits and Vegatables Prevent Cancer?

The answer in one word is "unproven." A large study involving 500,000 Europeans over a multi-year basis failed to show a definitive correlation between cancer development and fruit and vegetable consumption.

So if that's the case, why is it important to eat such whole foods?

Before I give you an answer, I want to point out the trap that you may have fallen into by even considering this question. If you've been reading this blog for some time, then at this point you should realize that when it comes to your health, X usually does not cause or prevent Y.

Yes, there are some notable exceptions like cigarette smoking causing lung cancer, trans-fats causing heart disease, etc. but it's almost never so simple.  True, we also know that sufficient levels of Vitamin A prevent night blindness, of niacin prevent pellagra, of Vitamin C prevent scurvy, etc. In other words, there are known cause and effects for certain diseases, but it's usually not one thing alone that causes the major killers such as heart disease, cancer, etc.

Why? The human body is a very complicated machine that is usually able to handle many imperfections (like autoimmune diseases, etc.) and environmental assaults (unhealthy foods, etc.) before it breaks down and stops working completely. It has many built-in mechanisms such as the immune system, the complement system, etc. that fight to fix problems before they wreak havoc.

Even in the case of really harmful things like smoking, not everyone develops lung cancer, one of the known consequences. Sometimes smokers die from the heart damage that smoking does and sometimes they die from something completely unrelated. (Many smokers who don't develop cancer from smoking do develop other lung diseases like emphysema and Chronic Obstructive Pulmonary Disease (COPD), the fourth highest killer of Americans.)

The point here is that it would be a mistake to think that anything, including fruits and vegetables, considered in isolation would prevent major diseases such as heart disease, the leading killer of Americans, and cancer, the second leading cause of death.

It is the sum of the parts that ultimately make a difference. If one eats lots of fruits and vegetables but simultaneously eats lots of processed sugar and other known carcinogens, the fruits and vegetables are unlikely to yield a high preventive effect.

So now let's come back to my question of why it is important to eat fruits and vegetables in regards to cancer.

The answer is that while no study has distinctly proven a cause and effect relationship between the amounts of fruits and vegetables one consumes (once above the deficiency threshold and below the toxicity level) and the development of cancer, there are certain factors that have proven to be strong risk factors for cancer development. One is weight. Overweight and obese people appear to have a markedly increased risk for development of a variety of types of cancer affecting both men and women. It is also a strong risk factor for cancer recurrence. For most people, their weight is a direct result of the types of foods they eat. People who typically eat more fruits and vegetables usually eat less processed foods like breads, crackers, pasta, etc. and weigh less. (See my previous posts 'Why You Get Fat?'  and the two part 'Why You Stay Fat?' for a more exhaustive discussion.)

As I previously wrote about a close relative that was recently diagnosed with cancer, I have taken a keen and deeper interest in the subjects of cancer prevention and survivability so that I may offer this relative the best guidance.

After review of hundreds of cancer prevention studies, I have reached some very tentative conclusions.

Fruits and vegetables alone (and clearly supplements including vitamins, minerals, antioxidants, etc. naturally found or synthetically produced to mirror such chemicals) do not alone prevent cancer.

However, as part of an otherwise healthy lifestyle that includes avoidance of known carcinogens such as smoking, drinking lots of alcohol, being overweight, exposure to environmental hazards such as asbestos and numerous other substances and chemicals such as acrylamide that develops on the surface of french fries during the frying process, nitrites used to preserve cured meats, certain food dyes, pesticides, and other chemical additives, etc., eating fruits and vegetables is likely to cut down one's risk of both developing cancer and dying from it.  As I previously wrote, the risk of men developing cancer is 1 out of 2 and of dying from it is 1 out of 4. For women, the numbers are slightly better with the risk of developing it being 1 out of 3 and of dying of it being 1 out of 5.

Cancer remains mostly a disease of random mutations instead of genetics.  What causes these mutations, why some get it versus others, and why some survive the exact same cancers while others die from them remains an issue of scientific debate. While science continues to try to figure it out, do yourself a favor and shift the odds in your favor. Substitute fruits and vegetables in place of processed foods, in addition to making many other known healthy lifestyle choices such as regular exercise, getting proper sleep, etc.  By doing so, you will give your body every opportunity to function at the optimal health level and to continue functioning for many more good years.