Iodine: Do you get enough and is the RDA adequate?

A month or so ago I decided I was going to do an article on iodine, and lo and behold Science Daily publishes a story on iodine deficiency being on the rise in developed countries.  For the most part, iodine deficiency is thought to only affect people in undeveloped countries because the US added iodide to salt back in the 1920s to combat goiter in landlocked states that didn't have access to soil or foods rich in iodine.  It worked, but perhaps this is one of the answers to increasing iodine deficiency in developed countries; who uses iodized salt any more?  In this two part series we will look at the roles of iodine in the body and how and why iodine levels have declined over the past forty years.  Let's take a look at iodine, element number 53 on the periodic table of elements and something I've found to be critically important to health and wellbeing.

Iodine vs Iodide

You will often see iodine and iodide used interchangeably when referring to the biological roles of iodine.  Iodine refers to the atom iodine(I) or the molecule iodine(I₂) while iodide is the negatively charged ion of iodine (I^-).  Most of the iodine on the planet is in the iodide form as it is water soluble.  Molecular iodine(I₂) is toxic and should not be consumed orally.  Iodide(I^-) is taken up by the thyroid where it is converted to iodine (I) and added to tyrosine to make the thyroid hormones T3 and T4, a process we will discuss in depth a little later.  Unless specifically noted, I will use iodine for both iodine(I) and iodide(I^-) within this article.

What foods contain Iodine?

Iodine is found in high concentrations in seawater, so foods that come from the ocean tend to be the best sources of iodine.  This includes sea vegetables such as seaweeds as well as fish.  Iodine is also found in many land foods such as broccoli, spinach, milk, and eggs.  The caveat with land foods is that the soil that they are grown in or, in the case of animals, the soil that the foods they eat are grown in must be high in iodine.  This is why it's important to rotate crops, if you continually grow spinach in the same soil it will deplete that soil of iodine and decrease the iodine content of foods grown in that soil.  Taking it a step further, animals who eat food from iodine deficient soil will also be deficient in iodine.  This is why looking up the nutrient contents of foods can be deceiving, while nutritionata may state that a food has x amount of a nutrient, there's no way they can tell what the condition of the soil the food was grown in is like.

A perfect case of this is the goiter belt, an area that encompasses the Great Lakes, Midwest, and mountainous areas where the soil is deficient in iodine.  People in the goiter belt are particularly prone to goiter, an enlargement of the thyroid gland.  As these people become deficient in iodine, their thyroids enlarge in order to trap more iodine from the circulation.  In 1924, iodized salt was introduced successfully to combat goiter in these areas.  In fact, the FDA recommendation of 150 mcg per day of iodine appears to be the dose of iodine necessary to prevent goiter.  This doesn't, however, mean that this is the optimal dosage for human health.

Thyroid gland and enlarged thyroid gland (Goiter)

Taken fromhttp://nandabooks.blogspot.com/2012/10/nursing-care-plan-for-goiter-assessment.html

Iodine and thyroid function

Iodine plays a significant role in thyroid function.  Thyroxine(T4) and triiodothyronine(T3) are the two hormones secreted from the thyroid gland that help regulate cellular metabolism(Energy production).  They get the names T4 and T3 because the number corresponds with the number of iodine atoms contained within each.  While T4 is the most abundant thyroid hormone, T3 is the far more active one.  T4 is broken down to T3 inside cells by selenium containing enzymes where it increases energy metabolism.

Iodide is trapped by the sodium iodide symporter of the cells of the thyroid gland from the bloodstream and imported in to the thyroid where it is converted to iodine.  In the case of iodine/iodide deficiency, the thyroid lacks one of the key components it needs to make thyroid hormones.  This causes an increase in thyroid stimulating hormone (TSH), a hormone that signals the thyroid to make more T4.  In an effort to trap more iodine from the bloodstream, the thyroid gland enlarges and produces a goiter.  In mild iodine deficiency, TSH levels may be normal because the body compensates by converting more T4 in to T3.  In this instance there may be a goiter present in someone with normal TSH levels.  However, the cells of the body require selenium to convert the inactive T4 in to the active T3, so if the person is selenium deficient this conversion cannot happen.  Selenium's role in converting T4 to T3 make it essential in protecting the thyroid while supplementing iodine.  In the acute sense, if a person with a goiter is given sufficient iodine and selenium the goiter will go away.  If the goiter has been untreated for five or more years, iodine therapy may not be able to get rid of the goiter.

Side view of a person with a goiter

Taken from http://www.taytan.com/images/goiter.jpg

Given that thyroid hormones regulate energy metabolism in all of your cells, you can see how important getting sufficient iodine is.  Cells that have insufficient thyroid hormones won't produce energy properly and, therefore, won't be able to perform their role in the body.  Muscle cells won't contract properly, neurons won't fire properly, and all cells will not be able to replicate properly.  Any process that requires energy will be affected, which is nearly every process.  As such, every system can be affected including the digestive system, immune system, nervous system, endocrine system, basically every system of the body.  The role of iodine doesn't end at the thyroid hormones, however, let's take a look at other roles iodine plays in the body.

Roles of iodine in the body

While most people associate iodine with the thyroid hormones, iodine also has other functions outside of this role.  A sodium iodide symporter (Primary transporter of iodine in to cells) has been found in the stomach mucosa and thymus gland(Part of the adaptive immune system).  In addition, the mammary glands of lactating mothers and the salivary glands concentrate amounts of iodine equivalent to the thyroid gland.  Finally, the skin, joints, arteries, bone, cervix, and choroid plexus all take up significant amounts of iodine(1).

Researchers have theorized that iodine may have an antioxidant effect in humans (1, 2).  This hypothesis comes from studies in animals that have shown an antioxidant role of iodide in the brain of rats(3) as well as the eyes of rabbits(4).  Furthermore, iodine deficiency has been show to increase oxidative damage in the thyroids of rats and mice as evidenced by an increase in the expression of antioxidant defense genes(5).  In humans, the thyroid and breast both concentrate large quantities of iodide and a have a highly efficient ability to neutralize hydrogen peroxide(H₂O₂), a potent free radical, by donating an electron from the iodide to the H₂O₂.  In the thyroid, the remaining iodine combines with tyrosine to make the thyroid hormones(6). It is theorized that low iodide leads to high levels of thyroid stimulating hormone (TSH) which produces higher levels of H₂O₂ that, since they are not being used to help produce thyroid hormones, cause oxidative stress to the thyroid gland.  This could be the beginning pathology that leads to thyroid cancer(7, 8).

There is strong epidemiological evidence that points to iodine deficiency playing a role in breast (1, 8, 9, 10), gastric(8, 11, 12, 13)  and ovarian cancers (10).  While there is conflicting evidence showing no role of iodine deficiency with gastric cancers(14) and the role of iodine deficiency hasn't been studied often in ovarian cancer, the role of iodine deficiency in breast cancer appears to have strong support and little evidence to contradict it.  People with iodine deficiency induced goiter are three times more likely to be diagnosed with breast cancer than the general population(1).  Furthermore, researchers have found a significant difference in urinary iodine excretion rates and women with breast cancer(9).  Urinary iodine content is a valid way of identifying iodine intake, has been used in multiple studies(10), and is a way to determine iodine sufficiency; something that will be discussed in part two of this blog.

In a study on iodine and breast cancer cells, molecular iodine induced apoptosis in 4 out of 5 breast cancer cell lines(15).  Apoptosis is programmed cell death and is a necessary measure the body uses to get rid of abnormal cells.  One of the hallmarks of cancer cells, along with higher levels of oxidative stress, is that they somehow manage to become resistant to apoptosis.  In vitro, iodine induces apoptosis in tumor cells while providing protective effects in non-tumor cells(16).  In an analysis published in the Journal of American Physicians and Surgeons in 2006, Miller provided a very thorough analysis of the association between iodine deficiency and fibrocystic breast disease(1). The two primary studies referenced in this analysis showed a 70% success rate in treating fibrocystic breast disease with iodine.  All of this evidence points to an important role of iodine in breast health.

Recommendations for iodine intake

The US RDA for iodine is 150mcg for adults, with an increase to 220mcg for pregnant women and 290mcg for lactating women.  The discrepancy between the RDAs is due to the nutritional needs of the fetus during pregnancy and developing child during breast feeding.  These numbers appear to be the amount of iodine required to prevent goiter in the general population and to prevent cretinism and mental retardation in the children of pregnant and nursing mothers.  The problem is that these numbers do not necessarily reflect what is optimal.  This is the problem with some of the RDAs of micronutrients as most were developed to prevent diseases of malnutrition such as rickets and scurvy and do not necessarily reflect what is optimal to human health.  In addition, the RDAs are merely snapshots in time and do not reflect increased nutritional needs that may occur due to changes in the environment as well as the food environment.  This is very important as certain environmental changes can increase or decrease your need for specific nutrients, particularly iodine.

Conclusion

As you can see, iodine has many roles in the human body.  While it's role in the thyroid hormones is critical to human health, it is important not to be myopic and ignore the other roles it plays in the body.  In part two of this series we will discuss environmental and food factors that may contribute to iodine deficiency as well as a new grass roots campaign forming over the internet with doctors and patients that are bucking conventional wisdom and using milligram doses of iodine to combat many of the health issues discussed above.  While iodine's role in health is important, as is any essential nutrient that you may become deficient in, it is important to not look at single nutrients as a panacea for all of the worlds ills.  Rather, you should look to optimize your life by living a healthy lifestyle and look to get optimal levels of all essential nutrients.  The question being asked in these blogs and by iodine researchers and physicians who routinely use it is if the RDA is sufficient for optimal health and not just to treat goiter.

Part 2

How to lose weight the Synergy Wellness way: Part 8: Mapping your quest

During the initial assessment I have with clients, most of them rate losing weight as one of their biggest life goals.  It only makes sense that they would list this in the top 3 since most of them are coming to me to lose weight, so this doesn't take me by surprise.  Their response to my next question, however, never ceases to amaze me.  When I ask them how they plan to do that, very few people ever have a specific answer.  While they know they want to lose 20lbs, they have absolutely no idea what they are going to do.  Sure, the standard answer of exercise more and eat less may come up, but how do they plan to do that?  Those aren't specifics, and most people are terrible at following general advice without specific parameters because it doesn't give them direction.  Let's take a look at how to properly set out on your goal to lose weight.

Breaking down goals

If one of your goals was to go on a vacation this year, you would have to do far more than just proclaim you want to go on a vacation this year.  How are you going to pay for your vacation?  Where would you like to go?  What time of year do you want to go?  How are you going to get there and back?  These are all very good questions that need to be answered in order for you to take that vacation. Sure, you've set your initial goal of going on a vacation, but once you do that you need to script the critical moves to actually be able to go on your vacation.  Most people understand this when looking at taking a vacation, why would planning for weight loss be any different?  Sticking with the vacation analogy, let's look at scripting the criitical moves to taking a vacation.

First, let's pick a destination.  I am a fan of warmer climates and the beach, so let's go to the beach.  Being in New Jersey, I have access to the beach and nice weather here from May to September, but I'd like to get out of town.  Since I normally get a little bit of cabin fever during the mid-winter months, I'd like to go somewhere that's warm and has a beach during late January or early February.  I will obviously have to fly wherever I want to go so that will be my mode of transportation.  I could go further with this analysis but it's not necessary.  As you can see, as I begin to script the critical moves the pieces fall in to place.  I have specifics and I can work with those specifics to get the plans to my vacation set.  My plans are falling in to place and I have narrowed down all of the general parameters in to specific critical moves that I can use to attain my goal.  I have a plan, let's set it in to action.  Let's see how a similar plan may develop for someone trying to lose weight.

Scripting the critical moves

Let's assume your goal is to lose 30 lbs in 4 months.  What do you think keeps you from attaining this goal?  Given that I get a good look in to many of the factors that prevent people from losing weight, let's make a fictional person with most of these problems.  First off, let's say you normally skip breakfast because you wake up late, drive 45 minutes to work, sit for 3 hours, have a tiny lunch, sit for 4 more hours, drive home in heavy traffic for 45 minutes, and finally get home to gorge on a huge dinner because you feel like you're starving, plopping on the couch for the rest of the night.  Despite a large dinner, you normally end up eating a carb heavy snack right before bed.  Let's script the critical moves within the framework we've laid out over the last 7 blogs to learn how to lose weight.

1)Begin eating breakfast so that blood glucose levels remain stable and you don't eat so much at dinner.
2)Listen to something funny during your commute to and from work to lower stress.
3)Find ways to organize your work so you can get up and move throughout the day.
4)Have a filling lunch.
5)Make a habit of going for a walk after dinner to increase physical activity and prevent the boredom associated with sitting on the couch that can lead to snacking.
6)Make a rule that you don't eat anything after dinner.

This is a pretty good start and scripts most of the critical moves.  There is not a significant amount of detail in the six moves we laid out, but there is enough detail to determine whether you are being successful at accomplishing them or not.  One of the biggest problems with being too vague about your moves is that it normally leaves wiggle room.  Trust me; if you leave wiggle room, you'll wiggle your way right out of accomplishing your goals.  Merely saying you're going to be "good" on your diet and exercise is too subjective to be an effective move.  In addition, having moves this vague may lead you to overvalue the progress you are making and cause you to "celebrate".

Your critical moves should be process moves, they shouldn't be weight targets.  Process moves are specific changes you are going to make to get you from point A to point B.  Notice how there is no mention of specific weight targets you want to hit.  Most people feel that a good plan would be to set weight numbers you want to hit each week, but this is a mistake because you are paying attention to numbers ather than what is getting you those numbers.  First off, if you set the target based on the final goal of losing 30lbs of weight in 4 months, the logical step is to say you need to lose about 2lbs per week.  The problem with this is that people who lose more will reward themselves with something that will tend to work against their long term goal.  Secondly, most people don't realize that progress is fast in the first few weeks then slows down considerably thereafter.  This means that while it will be easy to hit your numbers early on, later on you may regret giving up the extra progress you made early for a little bit of instant gratification.  Finally, our goal is to lose fat because water weight normally fluctuates with carbohydrate content and hydration status.  If you lose 5lbs of weight in the first week, most of this will not be long term weight loss, it will be water weight that will just fluctuate throughout the 3 months.  Even if you are using a scale that monitors body fat, they are far too inaccurate and swayed by hydration levels to give you a good idea of how much fat you are losing.  By sticking to process moves rather than weight targets, you can get a firm idea of whether your moves are getting you closer to your goal.

Implementing your moves

When making changes, especially major lifestyle changes, it's good to implement change in an incremental fashion.  Rather than changing every aspect of your lifestyle in one swoop, go after the low hanging fruit first.  Maybe your first move is to take a 30 minute walk after dinner every night since it's pretty easy to accomplish.  In addition to being one of your critical moves, it could help with a couple of your other moves.  Not only could it reduce or prevent you from snacking after dinner by regulating appetite, after a couple of days the reduced consumption of food after dinner may cause you to be hungry enough in the morning to begin eating breakfast.  Always implement moves that can help with other moves first, that way they become easier to implement as time goes by.

Once you decide the order of implementation, you'll want to come up with a schedule of implementation.  Most people love competition, so we make our implementation schedule a personal competition.  The critical moves are broken up in to 3 categories and you implement a new move every 3 days.  After you have implemented all 3 moves, you have to maintain those moves for 7 days to "graduate" from that level.  If you are on day 4 of implementing all of the level 3 moves and you mess up on a level 1 move you don't start back at level 1, but the 7 day clock on the level 3 moves restarts at zero.  You don't need to do it this way specifically, but you want to make sure it's structured in a way that is simple, keeps you engaged, and taps in to your competitive spirit.  You also want to have specific parameters for progress so you don't wiggle your way out.

Conclusion

When trying to attain a goal, whether it be to go on vacation or to learn how to lose weight, it is very important to break down your goal in to critical moves that will get you closer to reaching that goal.  Your critical moves should be specific enough to eliminate any wiggle room you may try to give yourself, and your critical moves should be process moves that are changes that will get you to where you want to be.  When trying to lose weight, most people just try to figure out how much weight they need to lose each week which is of no value if you don't know how to lose weight in the first place.  Finally, once you've identified your moves you want to look at how and when you want to implement these moves to reach your goal.  Arrange the moves in a way that makes sense and makes it easier to implement change.  Probably the best advice you can get if you want to lose weight is to make being healthy your primary goal, identify the critical moves you need to get there, set up a schedule to implement these moves, and just do it.

Salt: One of your best friends on the Paleo diet.

As web searches for "Paleo Diet" increase exponentially on a monthly basis, more and more people are giving the diet a whirl.  I have seen many people dramatically improve their health by making the switch from the Standard American Diet to the Paleo Diet.  While I think this is a great thing, it presents many challenges to the casual observer.  Many people believe they only need to move from point A to point B and how they make that move is irrelevant.  The problem with this line of thinking is that it can get you in to trouble down the road.  Many people can experience fatigue, headaches, constipation, and even thyroid issues if they don't implement the diet properly.  It seems like something that is easy enough to implement, remove all processed foods and you are good to go.  One thing you absolutely must do when implementing the Paleo Diet is increase your salt intake.  This can be problematic, particularly in a salt-phobic culture like ours.  Let's take a look at the importance of salt in the Paleo Diet.

Table salt(Sodium chloride) seems like such an insignificant thing since it is so plentiful, but it has a large impact on your health and the way you function given it is the primary source of sodium in the diet.  In fact, without sodium you would not be.  Sodium is important for fluid balance, electrical activity/nerve conduction, and the movement of other ions in to or out of our cells.  When sodium gets too low, it can cause major problems, particularly the ones mentioned above.  These repercussions are not solely due to a Paleo Diet, they are standard in all low carbohydrate diets.  While the Paleo Diet is not a low carbohydrate diet, it is typically much lower in carbohydrate than what most people are accustomed to eating since processed foods are eschewed.

When a person begins a low carbohydrate diet, they experience something known as the natriuresis of fasting.  Natriuresis is the excretion of sodium via the urine due to the action of natriuretic peptides on the kidneys.  Since water follows sodium, this also causes dumping of water via the urine.  Most people, in general, attempt to limit their sodium intake because that is what's recommended to them in the popular press.  While there may be a small portion of the population that is very sensitive to salt intake from a blood pressure standpoint, a low carbohydrate diet more or less removes that issue as the loss of sodium and water will obviously lower blood pressure.  Even if you aren't someone who tries to keep their sodium intake low, beginning any sort of low carbohydrate diet will increase your sodium requirements as your body flushes it out.  While the Paleo Diet does not have to be a low carbohydrate diet per say, most people will dramatically reduce their carbohydrate intake when they reduce or eliminate processed foods as they switch from a Standard American Diet to a Paleo Diet.  Let's take a look at the negative effects associated with this problem.

Dizziness/fatigue problems on the Paleo diet

While most people have a short adjustment phase when implementing the Paleo diet, people who implement it without increasing their salt intake can run in to dizziness or fatigue problems.  There are a couple of reasons that this can occur.  For one, the dizziness typically comes from low blood pressure.  When moving quickly from a seated or lying position to standing, your body doesn't increase blood pressure quickly enough so it takes a little longer and a little more effort for the blood to make it to your brain.  Many people mistake this for low blood glucose but it's remedied quite easily with a higher salt intake.

The lack of energy can be attributed to a couple of things.  For one, salt helps many other substances enter your cells because it follows an electrochemical gradient.  Salt always goes from high concentration to low concentration, so your cells actively take it in because their sodium levels tend to be lower than the blood.  This electrochemical gradient also helps pull other substances such as iodine, glucose, and calcium in to or out of the cell depending on what type of transporter you are dealing with and the concentration of sodium inside and outside of the cell.  When sodium levels drop, this leaves less sodium to move these nutrients in to cells which can negatively impact energy levels.  This is an important phenomenon, particularly with calcium and iodine.

The Sodium/Calcium Exchanger (NCX)

Muscular contraction is accomplished by moving calcium from an area of the cell called the sarcoplasmic reticulum in to the cytosol via calcium channels.  The muscle relaxes once the calcium moves back in to the sarcoplasmic reticulum.  In skeletal, cardiac and smooth muscle cells; calcium is pumped back in to the sarcoplasmic reticulum via the sodium/calcium exchanger (NCX) and Calcium ATPase pump.  The NCX is important because it uses no energy and can move large amounts of calcium quickly via the electrochemical gradient of sodium by moving 3  molecules of sodium in one direction and one molecule of calcium in the other.  Think of it like a child who wants to enter a building that is too weak to move the revolving door.  In order for that child to enter the door, they wait for someone strong enough to move the door to leave the building.  As that person exits, the child moves in to the door and allows the other person to power it.  The Calcium ATPase pump works in concert with the NCX but can only move small amounts of calcium and requires ATP (Energy) to power the process.  If there is not enough sodium to power the NCX, this means the Calcium ATPase pump must move all of the calcium and use up a lot of energy to do so.  This may be the primary reason fatigue creeps in during a low carb diet.  Increasing salt intake typically remedies the situation. 

Coincidentally, this also appears to be why people tend to become constipated on a low carbohydrate diet.  The NCX is highly expressed in smooth muscle, particularly the smooth muscle cells that line your intestines.  Not having enough salt to move calcium quickly may be one of the primary reasons many people become constipated or experience sluggish bowel movements on a low carb diet.  Increasing salt intake almost always fixes both of these problems.

One interesting note on the NCX is that it is also highly expressed in the adrenal glands.  Chromaffin cells, cells of the adrenal gland that secrete the stress hormones epinepherine(Adrenaline) and norepinepherine(Noradrenaline) in response to stress, show high levels of expression of the NCX.  When the NCX of these cells is inhibited, they secrete more of these hormones because the same movement of calcium that causes muscular contraction also causes hormone secretion(1).  When the NCX is inhibited, it takes longer to move calcium back in to the endoplasmic reticulum of these cells which increases the length of time these cells secrete hormones.  This could have implications in adrenal fatigue as the same NCX is found in the zona fasciculata of the adrenal gland which is responsible for secreting cortisol(2).  One of the hallmarks of adrenal fatigue is an inability to regulate electrolyte balance because aldosterone, the chief mineralocorticoid responsible for electrolyte balance via salt retention and potassium excretion, gets too low and salt is wasted via the urine.  Perhaps in the beginning stages of adrenal fatigue, aldosterone gets too low and cortisol is oversecreted because the NCX does not have enough salt to move calcium quickly.  This could cause cortisol to be secreted for longer periods of time and inhibit the hypothalamus from sending the signal to secrete more aldosterone.  Only a working hypothesis but interesting nonetheless.

The Sodium Iodide Symporter (NIS)

The sodium iodide symporter (NIS) moves 1 iodide and 2 sodium ions in the same direction and is the first step in moving iodine in to the thyroid gland to make thyroid hormones.  In this blog we will use iodine and iodide interchangeably, in the future one on iodine we will differentiate between the two.  The thyroid hormones T4 and T3 have four and three molecules of iodine contained within them, respectively.  Given that nearly every one of your cells is dependent on T3 to regulate it's metabolism (aka energy production), thyroid  hormone is pretty important for proper function and low thyroid can certainly negatively impact energy levels.  Without iodine, there are no thyroid hormones.  Without sufficient sodium to move the iodine in to the thyroid gland, there are no thyroid hormones. The salt wasting that typically happens as a result of a low carbohydrate diet may slow down iodine uptake by the thyroid by inhibiting the NIS.  This could be the mechanism by which going very low carbohydrate for too long can negatively impact thyroid function and could also contribute to the fatigue associated with low carbohydrate diets.  Again, a Paleo diet does not have to be low carb, but since it is lower carb than what most people tend to eat; increasing salt is a good idea.

Conclusion

Salt is your friend on the Paleo diet or any lower carbohydrate diet for that matter.  Looking at studies that examine the use of salt in the Standard American Diet can be deceiving because most people don't realize that these studies don't apply if you are eating a lower amount of carbohydrate than what is typical.  Since decreasing carbohydrate intake leads to wasting of sodium from the urine, the salt requirement for people who undertake a Paleo Diet increases.  Many of the unwelcome changes a person notices when switching to this type of diet; including fatigue, constipation, and dizziness and headache associate with low blood pressure; can be alleviated by increasing salt intake.  Most people consciously avoid salt because they have been told to by the popular press.  A person who avoids salt and begins a Paleo Diet may be in for a rocky road unless they increase their salt intake to help maintain blood pressure, help regulate fluid balance, and provide sodium to help power some of the transporters that help other nutrients enter your cells.

For more on the intricacies of low and lower carbohydrate diets, check out The Art and Science of Low Carbohydrate Diets.

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.

Click Here for part 8

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 part 7 of this series found here, 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.