How to lose weight the Synergy Wellness way. Part 7-Exercise

You want to know how to lose weight and use exercise to that end, eh?  Well, I have some bad news for ya, you're barking up the wrong tree.  This may come as a surprise coming from a strength coach, but exercise is very low on the weight loss totem poll.  In fact, I'd put it well behind every other variable we've discussed up until this point.  That is not to say that there are not many health benefits to exercise, just that helping you lose weight isn't one of them, at least not directly.  My intention is not to dissuade you from exercising, everyone should perform some intense physical activity 2-4 times per week.  I'm also not using it as a cop out to not give you the proper direction for exercise, you will leave this blog knowing what you should do for exercise to help you lose weight.  Let's get started by discussing why exercise can impede your ability to lose weight.

Compensation

In 2009, Dr. Timothy Church from Louisiana State University published a research study that looked at the effects of different amounts of exercise on weight loss in postmenopausal women(1).  The women were broken up in to 4 groups.  The control group performed no exercise and were told to maintain their regular activity while the exercise groups worked out for 72, 134, and 196 min/wk.  At the end of the six month study, there was no significant difference between any of the groups in terms of weight loss.  In other words, no amount of exercise helped them to lose any more weight than if they had just maintained their regular physical activity.  In addition, there was no significant difference in fat loss between the groups.  How does this appear to happen?  The answer, is compensation.

When people change one lifestyle factor this change tends to cause a ripple effect in other factors.  One of the more obvious changes is that when people begin to burn more calories, they also tend to eat more calories.  This is why it's so difficult for people to lose weight come January 1st, they decide to substantially increase their energy expenditure while at the same time cutting their caloric intake.  This leads to a situation where they are unable to control their appetite because their brain senses increased stress and decreased resources to deal with stress.  The natural response of a brain under stress is to increase caloric intake, particularly from carbohydrates as one of the primary roles of the stress hormones, particularly cortisol, is to increase blood glucose levels.  It does this by causing the liver to make more glucose and by increasing your appetite for glucose generating substrate, aka carbohydrates.  This is why cortisol is called a glucocorticoid, it's secreted by the adrenal cortex to help mobilize glucose.  In the above study, there was no difference in self-reported food intake between groups, but this type of reporting of data has been shown to be inaccurate in the past.  Increased food intake due to exercise has been identified as an issue in other studies(2, 3) and is a typical issue for most people when they begin an exercise program.  This type of compensation can be minimized by introducing exercise stress slowly and not implementing severe lifestyle changes in a sudden, poorly thought out manner.

Compensation from exercise also comes in the form of reduced physical activity throughout the rest of the day.  Anybody who has jumped head first in to a program on January 1st can tell you that they will typically be sore the next day.  When moving around hurts, it's not too big of a stretch to think that people will do it less.  This is a way that we subconsciously compensate for exercise.  If the intensity and duration of a workout is going to negatively impact your ability to move the next day, it's definitely not going to help you lose weight. 

Many people use large amounts of soreness as an indicator of a good workout, it's not.  Pain is one of the ways your body tells you to stop doing something.  If you put your hand on a hot stove burner it is the pain that tells you to stop doing it.  In the same way, overdoing it in the gym will lead to excessive amounts of soreness the next day and this is not a desired state.  It's fine to feel a little tight, but that should be remedied fairly easily with a mild bit of stretching and/or warming up.  The same goes for energy levels.  After a good workout, you should feel energized and alert, if you feel dead and shot you overdid it.

Using exercise to lose weight

When working with clients who are just trying to lose weight, the role of exercise in their wellness program is to keep them moving well, pain-free, and insulin sensitive.  The first step in this process is to help them move properly.  The best way to do this is to utilize the joint by joint approach, which also helps them move pain free.  The joint by joint approach identifies which joints are best suited to mobility or stability, and that gives you direction in developing those qualities in the specific joints.  Below is a diagram of the qualities each joint is best suited:

Joint by joint mobility/stability requirement
Taken from http://agogeblog.files.wordpress.com/2011/11/joint-by-joint-skeleton.jpg

With every one of our clients, we begin the program with a Functional Movement Screen(FMS) that will identify areas where the quality of movement is poor because one or more joints have dysfunction.  When this happens, there may or may not be pain in a separate joint because it is compensating for the other(s).  For example, many people with knee pain actually have ankles that are immobile.  In order for the kinetic chain to move properly, joints should alternate between mobility and stability.  Looking at the diagram, the ankle should be mobile.  When it's not, the knee must become mobile to allow movement which can cause pain because the knee is supposed to be stable.  Many people will work on strengthening their knee in this situation, but since the problem is at the ankle you need to fix the ankle first.  I can't tell you how many times I've had someone come in who has had knee pain from running their whole life that fixes the problem almost immediately by adding ankle mobility work in prior to running.

The FMS is a very easy, yet powerful tool.  I remember one 18 year old client who thought she would never get rid of her back pain have it eliminated in 2 weeks just by performing a proper foam rolling/stretching/activation program that utilizes the joint by joint approach.  She initially thought it was from an injury lifting up a stage, but lifting the stage merely brought her movement dysfunction to her attention.  She had been to chiropractors and physical therapists who couldn't help her, and all she had to do was pay attention to the joint by joint approach and perform a 20-30 minute warm up 2-3 times per week.  Be on the lookout as in the near future, I will be posting a video of the dynamic warm-up I do with all athletes and clients.  This is the general warm-up we start with, if the FMS identifies an area of need we will add something on top of this to fix the issue locally and then work on restoring the movement pattern(s).

Insulin sensitivity

In terms of improving general health and helping you lose weight, exercise is best used to maintain insulin sensitivity.  We have gone over this here and here, so we won't rehash the science on this topic.  Intense physical activity a couple of times a week improves your insulin sensitivity and cleans out your glycogen stores, allowing you to consume more carbohydrate before altering insulin sensitivity.  This is particularly important if you are obese, diabetic, or prone to either condition as these people tend to carry more of the Type II muscle fiber types(IIa and IIx).  To improve insulin sensitivity it is important to activate the Type II muscle fiber types on a regular basis by generating high forces.  Since Force=Mass x Acceleration, you can either move heavy objects or perform fast movements.

I personally choose to lift heavy weights 2 times a week for upper body and hit my legs every 10 days, but you could easily play a sport, sprint, or perform a plyometric program.  My personal program is pretty simple, for upper body I push in a plane of motion and pull in a plane of motion 2 times a week.  One week I'll do 3 sets of 4 reps for each and the next week I'll do 3 sets of 8 reps for each.  One day I will push and pull vertically and the other day I'll push and pull horizontally.  I also do some core exercises in between sets to give myself a rest and prevent my posture from getting bad.  Every 10 days I'll hit my legs pretty hard with plyos, strength training, or sprints.  I keep my leg volume pretty low because I'm always doing something active on the weekends.  That's it, for someone with my goals(Maintain strength and insulin sensitivity while being healthy) that is pretty much all you need to do.  If I enter a stressful week, am not sleeping well, or haven't been getting the proper nutrition I'll dial it back.  Someone with less training experience or whose goals include physique enhancement may want more volume, but for the vast majority of people simpler is better. 

Conclusion

Most people look to exercise as their immediate concern when trying to learn how to lose weight, which is why they fail.  Time and time again I have to get clients to go after the low hanging fruit first (Diet, sleep, stress, daily physical activity).  In the grand scheme of things, you are not going to undo 160 hours of living like a slob each week with 8 hours of exercise, it's not possible.  Most people look at it from a calories in vs. calories out perspective which is the primary hang up.  Yes, calories matter.  However, you cannot accurately predict the number of calories you are burning when you solely focus on exercise.  If you subconsciously reduce your physical activity throughout the rest of the day or eat more calories because exercise makes you hungrier, this is of no benefit to you.  In addition, your metabolism slows down when you reduce the number of calories you consume, and few people take that in to consideration.  As we learn more about epigenetics, we get a greater understanding of why we fail when we try to lose weight.  There are so many variables that you need to look at to figure out energy balance that there is no point in doing it.  Live a healthy life, get regular non-exercise activity time(NEAT), get your sleep, manage your stress, and eat a Paleo diet that is mostly vegetable matter by volume.  Once you have all of that down, perform intense physical activity a couple of times per week after you attend to any movement dysfunction with corrective exercise.

A new understanding of Type 2 Diabetes and Cardiovascular disease

A new discovery by scientists at the Harvard School of Public Health has brought us closer to understanding Type 2 Diabetes and the metabolic syndrome.  Adipose Protein 2(aP2), a carrier protein found in adipocytes and macrophages, appears to also act as a signaling molecule that adipocytes secrete to increase glucose production in the liver(1).  This is not the first study showing aP2 to be a contributing factor to Type 2 Diabetes and the metabolic syndrome.  Let's look take a look at some of the other data.

In a study in 1999, disrupting the aP2 gene in mice lead to a 40% drop in basal lipolysis and a 300% increase in the amount of non-esterified fatty acids stored within the fat cells of the mice with aP2 disrupted(2).  This indicates aP2 as a significant, if not the sole, contributor to the increase in fatty acid release from fat cells found in insulin resistance and the metabolic syndrome.  Within fat cells, it appears aP2 is the signal that says, "Enough, no more fat!"  Recall that Lipopolysaccharide (LPS) causes system-wide insulin resistance when it is introduced in to the body.  A  recent study showed that injecting LPS in to the leg of humans lead to muscle insulin resistance and increased lipolysis in fat cells; causing them to leak palmitate, one of the primary fatty acids stored in humans(3).  It is likely that the palmitate was shuttled from the adipocyte by aP2 as aP2 has a 2-3x greater affinity for palmitic acid than does KLBP, the other lipid binding protein found in adipocytes(4).  It appears LPS induced endotexemia is an integral step in the development of Type 2 Diabetes leading to not only muscle and fat cell insulin resistance, but also increased glucose production in the liver.  In addition, blocking aP2 expression in macrophages and adipocytes has been shown to both decrease inflammation as well as protect against insulin resistance(5).  The role of aP2 in the metabolic syndrome does not end there.

The gene for aP2 is also expressed in macrophages, cells of the immune system that engulf invaders in order to neutralize them  Recall from the last LPS blog found here that when LPS attaches to the cell membrane of macrophages that macrophages switch from metabolizing fatty acids to metabolizing glucose.  A byproduct from this switch, succinate, causes the secretion of IL-1Beta which induces insulin resistance in muscle cells and adipocytes.  When exposed to oxidized LDL, macrophages become foam cells and contribute to the accumulation of plaque on blood vessel walls as aP2 becomes the most upregulated gene(6, 7) and macrophages that are aP2 deficient show a reduced capacity to form foam cells(8).  In addition, it is IL-1Beta that signals muscle and fat cells to become insulin resistant and it is this insulin resistance that increases lipolysis in the fat cell and causes it to dump fatty acids, and potentially aP2, in to the bloodstream.

If all of this were not bad enough, high blood glucose causes an increase in monocyte production by bone marrow.  These monocytes move to blood vessel walls and prevent the removal of plaque deposits, which over time would increase plaque accumulation on blood vessel walls.  Reducing blood glucose levels prevents this increased production of monocytes and blood levels of the signaling molecule that causes this over-production of monocytes coincides with the level of coronary artery disease seen in Type 1 Diabetics(9).  This entire story could potentially be the vicious cycle that leads to cardiovasular disease.  Having a liver that over-secretes glucose because it thinks your fighting an infection cannot possibly help attenuate the situation.

When looking at this issue from an evolutionary biology perspective, it seems odd that an immune response would get so out of whack that it would cause these issues in an organism.  When we look at in the proper context, it is absolutely a beneficial trait.  In the vast majority of our time here, fasting blood glucose levels were probably between 80-90mg/dL.  A mild to moderate elevation in a blood glucose level that low is probably not going to lead to sufficient plaque accumulation, certainly not in comparison to the 125mg/dL+ fasting blood glucose seen in Type 2 Diabetics.  In addition, there was probably still sufficient physical activity during infection to prevent major rises in blood and glucose.  A muscle that is insulin resistant is not incapable of burning glucose, it is incapable of using insulin to store it.  Physical activity would still cause translocation of GLUT4 to the muscle cell membrane to take in glucose, the priority is not to prevent muscle from burning glucose it's to prevent circulating glucose from being stored in muscle tissue as it is needed for the immune system.  This would allow the organism to flee in the case of immediate danger while healing from an infection.  Once the infection is healed, it is unlikely that blood glucose levels would rise enough to prevent healing of plaque on blood vessel walls when a person has to actively go out and hunt or gather their food.

In a pretty thorough discussion of Otzi, the well preserved mummy of a 45 year old man who lived approximately 5400 years ago, Dr. Stephan Guyenet identifies a few health issues that Otzi experienced.  In addition to having a few of his major arteries calcified, Otzi had several signs of infectious disease including intestinal parasties, Lyme's disease, and an "unknown illness that occurred three times in the four months prior to his death."  Otzi also consumed significant amounts of grain, as evidenced by the belly full of wheat found in his stomach.  We will never know the specifics of Otzi's health, but the fact that there was significant infectious disease prior to his death as well as significant atherosclerosis points to a potential relationship.  Were the calcifications in his arteries accumulated over time or was his level of calcification a snapshot of his poor health at the time of his death?  Evidence points to atherosclerosis being a part of the human condition, is that role as collateral damage from an overactive immune system?  We certainly cannot ignore the effect intestinal parasites may have had on the composition of his gut flora as well.

One of the theories currently being kicked around for our chronic disease epidemic, and the basis for the Paleo diet, is that the storage proteins in grains and legumes as well as the casein found in dairy can cause a molecule called zonulin to open the tight junctions between cells of the intestinal wall.  This allows LPS in to the bloodstream, potentially initiating the above events to fight an infection that doesn't really exist.  There is clinical evidence that the Paleo diet leads to better cardiovascular profiles when compared to a Mediterranean diet(10, 11) as well as better glucose tolerance(12).  The chief difference between the 2 diets is that the Mediterranean diet allows the consumption of grains, legumes, and dairy.  Zonulin is a huge problem for people with Celiac disease because they tend to have high levels of it and the ingestion of gluten causes even higher levels.  Gluten causes the same response in people without Celiac disease, but to a much smaller degree.  In someone with a more robust immune system or who only gets minor doses of these offending proteins, it probably does no significant permanent damage.  This could change with age, however, as the immune system becomes less effective and potential changes in gut flora manifest themselves after  decades of eating foods that may not be suited to a healthy gut

If the triggers do turn out to be the proteins in grains, legumes and dairy; Western civilization is in trouble.  Processed foods are loaded with this stuff; just try to find one without grains (Wheat, corn), legumes (Soy, peanuts), or dairy (Milk, cheeses).  Another potential route for LPS to make it's way in to the bloodstream is via bacterial overgrowth in to the small intestine.  The type of bacteria you need to worry about primarily consume sugars.  Given that the average American eats about 130lbs of sugar annually, it is not unlikely that some of it may feed bacteria that could pose a problem.  At the very least, dumping that amount of sugar in to your bloodstream will negatively impact your ability to remove accumulated plaque from your blood vessel walls.  Over the course of 40-50 years, this could ultimately lead to your demise.

Conclusion

While this new discovery helps give us a mechanistic look at how blood glucose regulation and plaque accumulation on blood vessel walls may go awry in some instances, it still leaves quite a few questions to be answered.  Is this the most common way this process happens?  How do food reward and leptin fit in here?  Why is our brain wired so that we overconsume foods that are bad for us healthwise?  How is the gut flora involved?  Are these issues causes or effects?  None of this changes the fact that overconsumption will more than likely cause the same problems, but is it via the same mechanism or a different one?  Does food overconsumption eventually lead to reaching your genetic capacity to store fat and leaching of fatty acids, and aP2, in to the bloodstream to initiate the same process?  As you can see, whenever we find one answer, 20 more questions pop up.

How to lose weight the Synergy Wellness way. Part 6-Stress and sleep

When trying to lose weight, absolutely nothing has a greater impact than stress and for good reason.  Every other variable we have talked about including diet, exercise, and physical activity all use the stress response in some way to produce their effects on your ability to lose weight.  In addition, optimal health requires a properly operating stress response.  In this blog we will discuss how sleep and understanding the stress response teach you how to lose weight.

How proper sleep helps you to lose weight

Sleep restriction has multiple effects on your ability to lose weight.  Poor and/or restricted sleep duration leads to an approximate 20% decrease in leptin levels(1).  Leptin is a hormone secreted by fat cells that tells you when to stop eating.  A drop in leptin levels will cause you to eat more food than you normally would because your brain doesn't get the signal that you are full.  In theory, a 20% drop in leptin levels should lead to an increased consumption of between 350-500 cals per day for an average male(1); this approximates a 30-45lbs weight gain per year.  Since most of the studies are done with calories held constant under laboratory conditions, we can only guesstimate as to the amount of weight these levels of leptin could generate.

People with insulin resistance and type 2 diabetes tend to have leptin resistance, a situation where leptin levels are high, but the brain doesn't respond to it.  Leptin signaling is affected by insulin resistance and cells that are constantly bombarded by both of these hormones tend to downregulate receptors to them on their cell membrane.  This leads to constantly high circulating levels of both insulin and leptin which is highly inflammatory and compounds the problem of systemic inflammation even further.  Since the cells in the hypothalamus that regulate appetite are not listening to the signal from leptin, these people get the same effect as sleep deprived people do.  It's not that they are always hungry, it's that they don't know when to stop eating because the communication system that sends that signal is malfunctioning.

Sleep also affects many other aspects of your health that impact your ability to lose weight.  A single night of sleep deprivation has been shown to induce insulin resistance in multiple pathways (2).  Other studies have shown reduced insulin sensitivity(3, 4) as well as significant increases in the stress hormones epinepherine and norepinepherine (3) during periods of sleep deprivation ranging from 7 to 14 days.  In the shorter study, researchers looked at what happened at a genetic level during 7 days of sleep restriction.  The researchers designed the study in a way that would emulate real world conditions in the Western world.  During the sleep restricted portion of the study participants slept an average of 5.7 hours per night for a week while in the sleep sufficient portion of the study the participants slept an average of 8.5 hours per night for a week.  The sleep deprivation duration is highly comparable to real world conditions as 30% of American workers indicate they sleep 6 hours or less per night and many night shift workers get less(5).

In this study, there were 711 genes expressed differently during sleep restriction compared to sufficient sleep(4).  These genes were involved in sleep regulation and circadian rhythm, immune system/inflammatory response, metabolism, and the stress response.  In addition, oxidative stress increased in the sleep deprived state as did insulin resistance.  In the sleep deprived state, all of these genes were differentially expressed in a way that would negatively impact health and your ability to lose weight, including increased triglyceride levels.  Recall from the last bog that triglyceride levels are important as high triglyceride levels in the blood are indicative of a reduced ability to break down fat for energy, your primary goal when trying to lose weight.  So how does stress play in to this and how can understanding the stress response help you lose weight?

The Autonomic Nervous System

Your stress response is handled by a part of your nervous system called the Autonomic Nervous System (ANS).  Your ANS has 2 branches, the sympathetic and the parasympathetic.  The sympathetic branch of the ANS is responsible for the fight or flight response while the parasympathetic branch is responsible for rest and digest.  Your ANS basically partitions your resources to the more needed processes based on how you perceive your situation.  When you perceive a situation as stressful or you send signals to your body that indicate stress, the autonomic nervous system increases sympathetic activity which causes blood to flow away from organs of digestion and to your muscles so that you can respond to the stressor.  In addition, heart rate and blood pressure increase as well as respiration rate.  When a stressor is resolved or you begin to send signals to your body that the stressor is over, parasympathetic activity increases and heat rate, blood pressure, and breathing rate decline back to normal and blood flows back to the organs of digestion so you can recover from the stress.

Unfortunately, we are in a society that is stressful 24/7/365.  The stress doesn't need to be physical either, how you perceive the situation is just as important.  Worrying about bills, getting a job, passing finals, and breaking up with a significant other may not warrant a physiological change that partitions resources to fighting or fleeing, but that's precisely what happens whether the stress is real or perceived.  This is because the amygdala, the emotional center of your brain, has a direct connection to the hypothalamus.   In addition to regulating most every process in your body including appetite, the hypothalamus initiates the stress response by increasing sympathetic nervous system activity.  Over time, chronic activation of the sympathetic nervous system can lead to digestive issues as well as depressed immune function as the body constantly tries to respond to a stress that is never there.  This can lead to big problems because if you cannot digest or absorb your food properly, the vital nutrients your body needs to function properly will not get to your cells.

In addition, a chronically activated stress response prevents you from relaxing and falling asleep, which further impairs you ability to enter a parasympathetic state.  Forget trying to lose weight, at this point your health is probably deteriorating pretty rapidly and you need to hold on to everything you've got to make sure you survive.  Your body doesn't know that the late rent check isn't going to kill you, it perceives it as a life or death situation regardless.  A body under this kind of stress will not budge if you are trying to lose weight.

The question now becomes, "What activities will get me in to this situation and which activities will get me out?"  To answer the first question, the biggest contributor is probably poor stress management.  Not dealing with stress is a terrible way of trying to deal with it as it never goes away and that is the tack most people take.  Other frequent contributors to this state are poor sleep, binge drinking, high caffeine consumption, over-exercising, having a job where you have little control and high or low demand, a long commute to work, and poor nutrient quality in the diet.  Things that help you get out of this situation include dealing with stress, getting 8 hours of quality sleep a night, meditation, tai chi, yoga, stretching, massage, getting proper nutrition, laughing often, and trying not to put yourself in to stressful situations.  One thing I've found to be very helpful for people who have long commutes to work is to listen to stand up comedy on the way to work.

In our program we utilize a stress bank account where you have withdrawals (Stressors) and deposits (De-stressors).  Finding a balance that works for you is key in helping you learn how to lose weight.  Making sure every withdrawal is matched with a deposit will go a long way in helping you achieve your weight loss goals.

Conclusion

All of the variables we have discussed up to this point that are important in teaching you how to lose weight will impact your body's stress response system in some way.  One of the best ways to make sure your body is recovering from stress and not tipping toward too much sympathetic nervous system activity is to get adequate, high quality sleep.  Doing this will help regulate your appetite, allow you to deal with the stressors you encounter every day, and provide the optimal internal environment to help you lose weight.

In the next blog in this series, I will discuss exercise and it's role in how to lose weight.

How to lose weight the Synergy Wellness way. Part 5-Physical activity

So far in our "How to lose weight" series we have gone over the variables that are important to weight loss and gone in to depth about how just focusing on calories is not a valid way of learning how to lose weight from a nutrition perspective.  Over the next 3 blogs we will go over each of the remaining variables and how each one helps you lose weight.  You often hear from trainers, dietitians, and coaches that diet is the most important factor to help you lose weight.  I don't find that there is really an effective way to rank order these variables because all of them are necessary to be lean and healthy.  In other words, you can diet until you are blue in the face but if you don't get regular physical activity or non-exercise activity time(NEAT), get poor sleep, and don't manage your stress you will not lose weight.  Period.

I have never seen something as effective as the Paleo Diet in terms of turning around health challenges and helping people to lose weight.  However, I never see anyone get their ideal body or health without tending to the other 3 variables.  It seems that people feel that they can sit around all day long and go to the gym 4-5 days a week for 90 minutes at a time and expect that to get them from point A to B perfectly fine.  It doesn't work that way, your body operates under the authority of your genome, and there are certain environmental conditions that will help you lose weight, and others that will prevent you from losing it.  Today we look at physical activity and how it can help you to lose weight.

Fat burning-The only way to lose weight

When we are trying to lose weight, what we are truly trying to do is burn fat.  Before we talk about how you burn fat, let's define a couple of key terms in the process.  Triglycerides (TGs) are basically just fat.  TGs are the way your body stores fat, but TGs are also found in the blood once fat has been released from storage.  To release TGs from storage, the hormone glucagon signals an enzyme called Hormone-sensitive Lipase(HSL) to release free fatty acids from your fat stores.  We all know that water and oil don't mix, so in order for TGs to be carried in your water-based bloodstream, they are reassembled in lipoproteins that can carry them to target tissues such as muscles to be metabolized.  Most of us confuse lipoproteins with cholesterol as the terms LDL-C and HDL-C are typically used to refer to cholesterol by physicians. However, these are lipoproteins that carry cholesterol, not cholesterol themselves.

In order for TGs to be broken down, you need the enzyme Lipoprotein Lipase (LPL) to break them out of the lipoprotein that caries them in the bloodstream so they can enter cells to be used for energy.  What we typically see in people with Type 2 diabetes (T2D) is high levels of blood triglycerides, at least Caucasian people with T2D.  African Americans with T2D don't have high TG levels, and this is directly related to LPL activity.  In Caucasian people with T2D, insulin resistance impairs LPL activity leading to elevated TGs in the blood (1).  African American people with T2D, however, do not have high blood TGs because their LPL activity is not impaired by insulin resistance (1).  This phenomenon explains why blood TG levels and TG:HDL ratio can predict insulin resistance in Caucasian males but not in African Americans(2).  This does not mean that African Americans cannot become obese, even if LPL breaks a TG down in to it's component fatty acids and glycerol, you still need to burn those components or they will just get restored as TGs in fat tissue.

How to lose weight with NEAT

Let's get a handle on all of that science so we can understand how this information can help us lose weight.  The hormone glucagon signals HSL(Hormone-sensitive Lipase) in fat cells to breakdown TGs in to their component fatty acids and glycerol so that they can leave the fat cell and enter lipoproteins where they are reassembled back in to TGs that carry them to target tissues, particularly muscle, via the blood.  When the TGs reach the target tissues, they need to be broken down by LPL (Lipoprotein Lipase) so that they can enter the muscle cell to be burned for energy, otherwise they will get sent back to fat tissue for re-storage.  As you can see, LPL activity is very important for the proper breakdown of TGs that are released from fat cells so that they can enter muscle cells to be metabolized.  So how do we increase LPL activity so that this can happen and you can lose the extra weight?

In order for LPL to be activated, a muscle cell must be activated.  During muscular contraction, HSL and LPL are activated at the same time within the muscle cell(3).  The HSL within the muscle cell is used to breakdown TGs that are stored in the muscle cell while LPL is sent to the capillary beds that supply the muscle with blood to breakdown the TGs that are sent in lipoproteins from fat tissue.   In addition, their is LPL made in the capillary beds that also help breakdown TGs so they can enter muscle cells.  Recall from our discussion here that Type I muscle fibers are best equipped to burn fat and therefore have higher LPL activity.  This is important to note because Type I muscle fibers are recruited for all types of activity while the Type II muscle fiber types are only recruited for high intensity activity.

It appears that getting regular low level physical activity is more important for health and LPL activity than getting regular intense exercise(4).  Inactivity rapidly reduces the amount of LPL produced by a rate much greater than intense exercise can make up for.  In fact, getting regular low level physical activity and performing intense exercise appear to have separate mechanisms by which they improve LPL activity and health(4, 5).  Studies in rats have shown a 90-95% reduction in LPL activity in limbs that are restricted from muscular contraction (6)

When looking at NEAT and intense exercise time, it's not terribly difficult to see which one is a more important factor in how you lose weight.  Given that a week has 168 hours and the most avid exerciser will probably top out at 12 hours of intense exercise per week(7% of total weekly hours), NEAT is where the bulk of your weight loss efforts should fall.  Of the variables that affect energy expenditure, NEAT is the most variable in that a sedentary person will burn 15% of his or her daily calories through NEAT while an active individual can burn upwards of 50%(7).  Couple this with the improved LPL activity and you will be a fat burning machine.  It's ironic that most people worry about eating 5 times a day when trying to lose weight given the fact that the thermic effect of food only accounts for 10-15% of total energy expenditure, talk about putting all of your eggs in the wrong basket.

Factors affecting NEAT

There are a host of factors that will subconsciously affect NEAT, and thus your ability to lose weight.  The weather and seasons have an effect on NEAT, as does your occupation(7).  Increasing caloric intake tends to increase NEAT while decreasing caloric intake tends to reduce it.  Anecdotally, I have found that clients who work in enclosed areas also tend to have a much lower NEAT and NEAT also tends to decrease the day of and following an intense workout.  As mentioned, we measure NEAT with a Fitbit activity tracker which helps to keep NEAT where it should be by making clients conscious of it and helps determine the amount of NEAT a person needs to help them lose weight. We look at more data than the total number of steps, but for most people daily steps is sufficient enough to give them an idea of how much NEAT they need to lose weight.  For the first few days we have clients wear the Fitbit and not attempt to increase NEAT so we can get an idea of where we should start them as well as how big of an impact a lack of NEAT has had on their stalled weight loss efforts.

Conclusion

When trying to learn how to lose weight, you need to focus on all 4 of the primary variables associated with weight loss before you even begin to worry about exercising.  Your goal for each variable is to make sure that each one puts you in a position to burn fat.  You want to send the proper signals to your body that your goal is to lose weight and you want to put your internal environment in to a position that will utilize the fat you have stored from excess/improper food consumption, sedentary behavior, poor sleep, and poor stress management to do that.  From a physical activity perspective, this includes spending as little time sitting as possible as well as increasing Non-exercise activity time(NEAT) so that your body will continually metabolize fat, this is how you lose weight.  Without consistently high levels of LPL to help breakdown fat so it can enter your muscles, you will not be able to lose weight.  You may see the number on the scales move, but all you will be doing is shifting hydration levels and/or catabolizing muscle.  Neither one of those is an effective long term strategy to lose weight.

If you have a Fitbit and would like to get involved with some challenges to increase NEAT, "like" our "Synergy Wellness Program" facebook page and you can get involved in some of our challenges.  If you'd like to buy a Fitbit, they can be purchased at Best Buy or online at Fitbit.com

In part 6 of this blog series we will discuss the role sleep play in teaching you how to lose weight. 

Genetic pathways involved in meditation discovered...again

Meditation has been shown in numerous studies to be very beneficial for reducing stress, helping you lose weight, and improving your health.  I am personally a big fan of mindfulness meditation and have seen numerous improvement since I began practicing.  A recent study conducted in Massachussets and published in the journal PLOS ONE has identified the genetic pathways through which relaxation triggers these physiological responses in the body.

The study identified several genetic pathways important to health that were changed acutely during bouts of practicing the relaxation response and over an 8 week course.  Participants practiced a relaxation response sequence that included diaphragmatic breathing, mantra repetition, and mindfulness meditation.  Practicing the relaxation response increased expression of genes related to energy production, mitochondrial function, insulin sensitivity, and telomere length.  Genes that were suppressed were genes involved in inflammation as well as the stress response(1).  The 6 of you who read my blog may recall that mitochondrial dysfunction, inflammation, and oxidative stress are a large part of the generalized disease state that leads to diseases such as Cancer, Type 2 Diabetes, Cardiovascular disease, Alzheimer's disease, and Parkinson's disease.  Telomere length is thought to be a good biomarker of aging and is reduced by high levels of inflammation and oxidative stress.

In addition to the acute changes seen within individuals, people who are considered long time practitioners of the relaxation response had even greater improvement in these genetic pathways.  People who practiced of yoga, meditation, and repetitive prayer for over 4 years were considered long time practitioners.  This study builds on earlier findings of the same authors from 2008 that found over 2200 differentially expressed genes between long term practitioners of the relaxation response compared to non-practicing controls and over 1500 genes differentially expressed between people who underwent an 8 week relaxation response course compared to controls(2).  The differentially expressed genetic pathways were similar between the 2 studies.  The results of the newer study are more intriguing as they identify genetic pathways within individuals that change as a result of practicing the relaxation response rather than genetic changes between people who practice the relaxation response and those that don't.


Mindfulness meditation is a good way to begin the practice of mindfulness, a way to respond to situations and crises without activating the stress response.  These studies indicate that practicing the relaxation response on a regular basis provides multiple benefits to your health. We live in a world that activates our stress response 24/7 with little time for relaxation.  Taking 20 minutes per day to practice yoga, mindfulness meditation, or any other activity that initiates the relaxation response can prove to be very beneficial to your health and happiness by both preventing disease as well as reducing stress.

How to lose weight the Synergy Wellness way. Part 4-Nutrition

In the previous 3 blog articles we discussed the 4 lifestyle factors that will help you learn how to lose weight.  For nearly everyone, losing weight is something they are terrible at.  For the most part, this has as much to do with the philosophy they follow to lose weight as it does their willpower.  Within the Synergy Wellness Program we use a process that not only teaches you how to lose weight, it also improves overall health and energy while giving you relief from the everyday pain that has become a constant part of so many peoples' lives.  In addition, you will find that you get sicker fewer times per year and the length and symptoms of those sicknesses are far more manageable.  Let's take a look at this process and how it teaches you to lose weight.

Counting calories to lose weight and gut bacteria

Most people believe the way to lose weight is to count the calories they eat and burn and try to make sure they burn more than they eat. This paradigm will help people lose weight, but it ignores quite a large chunk of what we know about factors that significantly contribute to weight loss outside of calorie counts.  For example, what you eat has a fairly large impact on how many calories you burn, as does how much you eat.  In a study performed in 2011 by Jumpertz, et al., people who had a shift in gut bacteria that increased firmicutes and decreased bacteroidetes absorbed 150 calories more from their diet than people who did not have this change in gut flora(1).  While this may seem insignificant, over the course of a year it would lead to a weight increase of approximately 15lbs.  This change in gut bacteria has been seen experimentally in humans (2) and in mice(3).  Furthermore, switching the gut bacteria of obese mice with lean mice causes the lean mice to become obese and the obese mice to become lean (3).  Changes in gut bacteria are generally driven by the content of the diet, and a study in 2011 found that the health of elderly people (Frailty, co-morbidity, inflammation, nutritional status) was strongly related to the composition of their gut bacteria(4).  Something you need to consider if you want to know how to lose weight is that as the composition of your gut bacteria evolve, so do you.  These bacteria manufacture nutrients such as vitamin K2 that you can't make or get through diet.  They also produce a large portion of your serotonin, the feel good neurotransmitter that is the target of many anti-anxiety and depression drugs that also has a role in appetite as people with low serotonin tend to overeat carbohydrates because carbohydrates increase serotonin(5)  Your gut bacteria can evolve in a way that helps you lose weight, but they can also evolve in a way that makes it difficult to lose weight as well.

To lose weight, repair your gut

The problems associated with counting calories to lose weight are not solely related to gut bacteria.  As mentioned in this blog as well as this one, the endotoxin lipopolysaccharide (LPS) can induce insulin resistance throughout the body when it attaches to receptors on cell membranes.  LPS normally enters the blood when the intestinal wall becomes compromised, also called a leaky gut.  It is normal for LPS to be in your gut, it's not normal and certainly not good to have it in your bloodstream.  When LPS attaches to the cell membrane of immune cells called macrophages, they secrete the inflammatory messenger IL-1B.  Chronically elevated IL-1B levels have been shown to induce insulin resistance in adipose tissue(6) and negatively impact insulin secretion by beta cells in the pancreas (7).

Compounding the problem is the notion that adipose tissue can secrete IL-1B as well, further increasing IL-1B levels and, potentially, insulin resistance.  IL-1B secreted from visceral fat has been implicated in hepatic insulin resistance as well(8).  Insulin resistant people have problems when they try to lose weight because their insulin levels are always high and insulin blocks their ability to release body fat, increases appetite by not allowing cells to take in glucose that comes from carbohydrates, and can negatively impact energy levels. Chronically high insulin levels also cause a switch in muscle fibers from the more insulin sensitive IIa fibers to the most insulin resistant IIx fibers.  If you are prone to Type 2 diabetes, chronically high insulin levels will get you there.  If you are prone to putting on fat, especially around the middle, high insulin levels will get you there.  If you are trying to learn how to lose weight, high insulin levels will slow you down.

Food sensitivities

The problem with LPS inducing insulin resistance is primarily driven by this immune reaction increasing inflammation throughout the body.  LPS, however, is not the only way you can induce this type of inflammation through diet.  Hidden food intolerance can also be a problem if they increase histamine levels which, in turn, increase IL-1B levels.  Food sensitivities are different than allergies because allergies cause a near immediate IgE immune response while a sensitivity can take hours to produce symptoms and are more chronic in nature.

In both situations histamine is released, the only difference is that a food allergy is an immediate, permanent, and obvious reaction to a food while a sensitivity is typically temporary and the symptoms are not as severe so they are less recognizable.  Since most people know when they are having an allergic reaction to a food due to the severity of the reaction, they do not typically affect your ability to lose weight.  Since food intolerance tends to be hidden, people do not realize they are having an issue with the food so they continue to consume, chalking up the boating, sleep problems, headaches, and other delayed reactions to something else.

Lactose intolerance is a fairly common problem for adults as we tend to lose the ability to make the enzyme that breaks lactose down after the age of 2.  You can also have a dairy intolerance while still making the enzyme that breaks down lactose because casein, a protein in milk, is hard to digest for humans.  Gluten intolerance is another common food intolerance to a protein found in wheat in abundant amounts.  However, all grains and legumes contain storage proteins that are difficult for most people to digest.  Some people have adapted to our current food environment and are capable of digesting these proteins, the only way to find out if you are is by eliminating the problematic proteins for 8 weeks and then begin to reintroduce them.  Enter, the Paleo regression diet.

How to lose weight using a Paleo regression diet

Using a Paleo regression diet to lose weight will cover all of your bases.  Removing grains, legumes and dairy for 2 months and then beginning to reintroduce them one at a time will allow you to determine if you have a sensitivity to any of these foods.  You may be surprised to find out that what you once thought was an allergy or sensitivity to one food is actual coming from another.  A sensitivity to the sulfites found in wine is common and many people avoid red wine as a result.  I've had clients who avoided wine for decades with constant migraines find out during their regression diet that their sensitivity was to dairy, not sulfites.  Now they drink wine and only get migraines when they eat dairy.  Other clients, including myself, have identified food intolerance to be the primary cause of the symptoms related to seasonal allergies.  As long as they avoid the foods they are intolerant to their symptoms never appear.

The regression diet is also a good way to heal any injury to the gut wall and fix an imbalance of the bacteria in your gut.  This will prevent LPS from entering your bloodstream and inducing insulin resistance.  Our specific approach includes ample amounts of soluble fiber found in vegetables.  The bacteria in your gut ferment soluble fiber in to short chained fatty acids, particularly butyric acid.  Butyric acid is used by the cells of your intestinal wall to heal the gut lining, sealing a leaky gut(9).  In order for this process to occur, you need to have the proper balance of gut bacteria in your gut and you have to provide substrate for them to ferment in to the short chained fatty acids that heal the gut.  Since the damage to your gut may be the accumulation of many years of damage, you may be able to resume eating things that once caused a problem after the 2 month regression diet.  As long as you continue to lose weight and remain free of symptoms you are repairing your gut at a faster rate than you are causing damage to it. 

All of this is not to say that you can't lose weight counting calories, only that counting calories while ignoring all of these other issues will lead to lackluster weight loss.  In a metabolic ward where you are fed a precise number of calories and everything else is held constant, counting calories may be effective.  However, in the real world where we are constantly bombarded by snacks and food advertising, appetite is a huge factor in how you lose weight.  In addition, the composition of your gut bacteria is obviously important.  That is not to say counting calories will not affect this, it will.  However, the composition of your gut bacteria as well as the health of your gut barrier is primarily determined by what you eat as specific bacteria consume specific components of foods.  Cutting back on snacks and processed foods can bring you part of the way in establishing gut bacteria that will help you lose weight by providing less food for the bad bacteria, but you also must feed the good bacteria with plenty of plant matter to help maintain healthy gut barrier function.  Eating a large diversity of foods will help accomplish these tasks and set you on your way to learn how to lose weight.

Conclusion

Everybody is different.  How you lose weight may be very different than how I lose weight at the onset of each our journeys.  Each of us is adapted to the environment we have put ourselves in over the course of our life and that will be different for most people.  That environment will shape the health of your gut, the types and diversity of bacteria in your gut, and the inflammation within your body.  In addition, each of us may have completely different sensitivities to food that can be improved by fixing the damage caused by our reckless lifestyle.  On top of all of this, the genes each of us has inherited from our ancestors will dictate how likely we are to become obese, our risk for Type 2 diabetes, and how our internal environment responds to the external environment via hormones.  If you want to learn how to lose weight, your weight loss paradigm should take all of these factors in to account and not merely the number of calories you eat or burn.  Putting yourself in to the proper hormonal state is paramount if you want to lose weight, and a Paleo regression diet can get your body in a position to be in that state so you can identify the things that may be holding you back.  It will also give your gut time to heal so that you can enjoy foods that may have been holding you back and causing reactions via the leaky gut.  Adding foods back one at a time after 2 months will give you the personalized nutrition program you need to learn how to lose weight.

In part 5 of this blog series, we will discuss how regular daily physical activity helps you to lose weight.

LPS, insulin resistance, and obesity...An update

A new study in the journal Nature has opened up a new understanding in the relationship between obesity, inflammation and insulin resistance that could also have a larger impact on how we view weight loss, and more importantly health and well being.  The study, published in Nature in March of 2013, has lead to a shift in my line of thinking.  Recall from this blog that when Lipopolysaccharide (LPS) manages to find it's way in to your bloodstream via a leaky gut, it induces system-wide insulin resistance.  It seemed as though this would be a good strategy to conserve glucose for the brain, but this new study in Nature implies a different reason.

LPS, fuel selection, and cellular communication

The study, located here, identifies a metabolite called succinate as a signaling molecule in immune cells called macrophages that causes them to increase secretion of the inflammatory molecule IL-1B(1).  Succinate levels increase because macrophages shift their metabolism from oxidative phosphorylation (Fat burning) to aerobic glycolysis (Sugar burning) when LPS attaches to receptors on the plasma membrane.  This would increase macrophage activity as glycolysis produces energy much more rapidly than oxidative phosphorylation, something you want when a foreign invader enters you bloodstream.  Theoretically speaking, when succinate increases IL-1B, it is telling the rest of your cells that glucose is needed to fight the infection rather than for powering muscular contraction.  Perhaps the relationship between inflammation and insulin resistance is simply communication between body systems (Immune and musculoskeletal) to partition resources(glucose) to the more pressing need(fighting an infection).  Click here for a not-as-sciencey rundown of this. This is not to say there is no benefit to the brain in this scenario, but since the signal originates from the immune system we should focus there for a bit.

When the scientists blocked succinate production with the anti-epilepsy drug vigabatrin, they were able to inhibit expression of IL-1B, cutting down the level of inflammation.  High IL-1B levels are seen in many diseases including diabetes.  Let's take a look at some of my older blogs and see where this all fit's in to the obesity/diabetes discussion.

Previous Type 2 diabetes discussion

Recall from here and here that Type 2 diabetics and people prone to obesity tend to have a higher percentage of Type IIx muscle fibers and a lower percentage of Type I fibers. There are 3 basic muscle fiber types: Type I, Type IIa, and Type IIx.  The type I fibers burn primarily fat, the IIa fibers burn primarily glycogen, and the IIx fibers burn primarily ATP as they do not tend to store much energy in the form of fat or glycogen to recharge ATP.  However, the Type II muscle fiber types can convert in to one another with physical activity or a lack of it.  When a person becomes sedentary over long periods of time, the IIa fibers begin converting to IIx fibers as their need to store glycogen to recharge ATP stores is not needed because they are not used.  When a person begins using the IIx fibers more with physical activity, they convert in to the IIa fibers as they begin to store more glycogen.  This leaves them with more room to store glycogen which gives the glucose from excess carbohydrate consumption a place to go.  However, this point is moot if LPS is inducing system-wide insulin resistance by partitioning glucose to the immune system and away from muscle cells.

This causes a double-edged sword scenario.  On the one hand, having a higher percentage of Type II muscle fiber types means a larger portion of your musculature uses glucose as a fuel supply.  In a trained state this is beneficial but in an untrained state you have a larger percentage of muscle fibers that don't use energy.  The problem is, as discussed in the first blog mentioned in the above paragraph, high insulin levels are what cause the IIa fibers to convert to IIx fibers.  Since the IIx fibers are the most insulin resistant of the muscle fibers, LPS induced system-wide insulin resistance can force adaptation in a way that will just make you progressively more insulin resistant, even when you are no longer directly dealing with LPS in the blood. As such, high levels of LPS need to be dealt with and avoided altogether if fixing insulin resistance is your goal.  However, we still have the other edge of that sword to deal with.

Since people who are prone to diabetes and obesity have a higher percentage of Type II muscle fibers, this means they also have a lower percentage of Type I muscle fibers.  Recall that the Type I muscle fibers burn primarily fat.  If LPS is inducing insulin resistance to spare glucose for the immune system, this means muscle is going to have to metabolize fat.  The problem here is that a lower proportion of Type I muscle fibers means a reduced ability to metabolize fat.  This effect, coupled with a decreased ability to suppress fatty acid release from adipose tissue(2) could be why we see something that is common in people with Type 2 diabetes, high levels of triglycerides in the blood.  We also see an accumulation of triglycerides in tissues that should not have high triglyceride levels such as muscle and liver tissue(2).  In people with a higher percentage of Type I muscle fibers, this may not be a concern as they are more equipped to metabolize fat and the Type I fibers are the most sensitive to insulin. This could help explain why they are less likely to contract Type 2 diabetes.

Conclusion

As you can see, having LPS in your bloodstream is far from an ideal scenario.  It has been hypothesized that the consumption of grains and dairy can increase the likelihood of LPS making it's way in to the bloodstream via a leaky gut.  This could potentially be one of the reasons a Paleo diet has been shown to improve glycemic control at a rapid rate, much faster than a Mediterranean diet (Paleo lowered FBG by 23 mg/dL in 10 days vs 0mg/dL for Mediterranean diet)(3).  The primary difference between these 2 diets is that the Paleo diet is grain, legume and dairy free while the Mediterranean diet is not.  In this particular study, they did not measure IL-1B levels and in other studies they measured CRP levels with no significant change (4).  Given the results of the recent study in Nature, perhaps measuring IL-1B  in a study comparing the Paleo diet with the Mediterranean diet can give us an answer to these questions and bring us closer to understanding more of the mechanisms that underlie insulin resistance and Type 2 diabetes.