Looking for the reason why you can't I lose weight or why you keep gaining it?

I am a member of quite a few facebook groups and work with people trying to lose weight and this question comes up very often.  To me, it really isn't rocket science and I can typically find at least a couple of things that people do that hold them back from attaining whatever health or weight loss goals they are trying to attain.  More often than not it's because they take an overly myopic attitude towards weight loss.

Over the course of the last couple of weeks I have come up with a checklist that I will be using with my clients to help them troubleshoot their weight loss issues.  The impetus for this is two-fold.  First, I may see someone in a Paleo group say they are sticking to the diet to the T but not losing weight or someone in a Fitbit group say they are getting their steps in but nothing is happening.  More often than not, when I question what they are doing for the other variables they should be paying attention to, they aren't doing anything.  I see the same thing with clients.  They may be getting their steps in every day, eating a proper diet, or getting in 3 weekly workouts but they aren;t doing all of these things consistently.  The second reason for the checklist is that it will gamify the process and provide a measure of accountability for my clients that they didn't have before.  Gained some weight this past week?  Look at the list.  Think you were good on your diet this week but not sure?  Look at the list.

While I am only using the checklist with my clients right now, I think a lot of these, "Why am I not losing weight?" questions can be answered simply by paying attention to the primary lifestyle factors that a person trying to lose weight should be paying attention to and creating a checklist to make sure yo are doing them.  I have my own specific way of dealing with each factor that I won't get in to, but most people will have an answer to that question simply by knowing what is important for weight loss and general guidelines for each.

1)Sleep

If you're not winding down at the end of the day and getting to bed at a reasonable hour, you basically trash your ability to lose weight by messing with hormone signaling, especially insulin.  You should put yourself in bed with the lights off and no distractions at least 8 hours before you need to get up.  This is a bare minimum.

2)Stress

Stress should be managed for the same reason.  One thing that sticks out like a sore thumb to me is that people who manage stress poorly also tend to have a difficult time losing weight.  I don't think there is a single reason why this is the case, there are many.  However, one glaring issue for me is that people who are not "planners" don't typically manage stress well and are the first ones to regress on weight loss when an opportunity presents itself.  I used to be guilty of this myself on numerous occasions.  If I put myself in to a situation where people are eating junk food and I haven't planned for this by having a healthy option for myself, I'll eat junk food.  If I know I am going to have a heavy client load one week and don't attend to it until the last minute, I won't work out that week.  If I am taking a 7 hour car trip and I don't make a point to get some low level physical activity in before and/or after it I won't get any in.  A quote attributed to Benjamin Franklin sums this up nicely, "If you fail to plan you plan to fail."

3)Intense physical activity

Whether it be working out with weights or playing a sport competitively or in a social setting, people really need to get intense physical activity in regularly.  I used to believe that 2 times a week was sufficient, but now believe that 3-4 times a week is significantly more effective.  In order for something to qualify for this factor, it should include the entire body and generate a significant sweat.  Good examples are weight training, flag football, rowing, or rock climbing. More often than not, this activity should also be 45 minutes to an hour long.

4)Daily physical activity

Many people feel that blowing themselves out at the gym 3-4 times a week is enough physical activity to lose weight, but multiple studies show that it can't make up for sitting around all day long.  At a bare minimum, people who wish to lose weight should be taking 10,000 steps a day which equates to 5 miles of walking throughout the day.  If I were to say that any one of these factors is the most underutilized, it's this one.

5)Nutrition

People who are trying to lose weight should be eating a highly diverse diet that is mostly of plant origin by volume and contains little to no processed food.  If most people did this they would have no problem losing weight and would score quite a few weekly points on my checklist.  Where it gets tricky for most is that this requires a lot of preparation and a lot of people shop for convenience.  However, if I had a dollar for everyone who told me that they'd give anything to get to their goal weight I'd be a rich man.  In the grand scheme of things, utilizing 5-10% of your day preparing the proper food is a fairly small price to pay for someone willing to do "anything".

6)The "It" factor

What is the "It" factor and who has "It"?  Some may call it mental toughness, some may call it willpower, but I believe it to be more than that.  The "It" factor is knowing what you need to do to achieve a goal and the willingness to do that to achieve it.  Michael Jordan had the "It" factor.  Michael Phelps has the "It" factor, and many captains of industry and people who have become elite at what they do have "It".  From a weight loss perspective, "It" is preparing lunches for the week on Sundays if that's what you need to do to eat properly at work.  "It" is waking up 20 minutes earlier so that you can take a 20 minute walk after breakfast before your 30 minute commute.  "It" is resisting the inertia holding you down on the couch to watch TV after you eat dinner and going for a walk or work out.  "It" is realizing that the end of the fiscal year is a busy time of year for you at work so you plan your workouts accordingly.  Neglecting these things may seem small, but it adds up over the course of a year.  People with the "It" factor just do "It", and as a result they typically get "It".  The whole reason to develop a checklist for yourself is to determine if you are getting "It" done.  In fact, "It" is exactly what your checklist should measure.

Conclusion

Looking at these 6 factors, it may seem like weight loss is a lot more than burning more calories than you eat, and it is.  However, knowing about these factors and paying attention to them is just part of being successful when it comes to weight loss.  More than any other factor, success in any field is dictated by persistence, or the "It" factor.  Pick a sport and anyone who is highly successful at it can be found practicing while their friends and lesser talented competition are on a beach or hanging with friends.  Look at any successful business person or parent, and you will find that their priorities align with what it is they truly want to be great at.

None of these things just come to people, they have to be worked on and perfected over years of practice, failure, and refinement.  Weight loss is no different.  People who want to be successful at it work at it and prioritize it in their life.  They don't run in to situations every week where they have nothing to eat but food that goes against their goals.  They don't skip workouts because something else comes up or because work or family life is getting busy.  Day in and day out they make sure they get done what needs to get done.  If something pops up and they can't work out at their designated time, they are working out late that night or first thing the next morning.  They get their steps no matter how busy they are.  There are 24 hours in a day, there is plenty of time to work, enjoy your family, AND work on your goals if you truly want to attain them.  The trick is to know yourself and learn the techniques necessary to prioritize your weight loss goal.

Evolution, physical activity, and human health

The chronic diseases we see today are often the result of poor lifestyle choices.  Cardiovascular disease, Type 2 diabetes, obesity, cancer, arthritis, depression, and Alzheimer's disease are all considered normal parts of the aging process and are often called diseases of aging.  The problem is, when you look at "less civilized" cultures, particularly modern day hunter gatherers, these diseases either don't exist or are insignificant even in older members.  This has caused many to postulate that the Western lifestyle may be a significant factor in the prevalence of these diseases.

In 2002, Booth wrote a paper going over exercise and gene expression(1).  This paper is a classic in the evolutionary medicine arena because it shined a light on the effect of exercise on gene expression and proposed the theory that genes expressed as a result of physical activity would promote disease in a person who doesn't meet the necessary threshold to activate these genes.  In other words, the lifestyle diseases that are often attributed to aging may be, at least partially, from a deficiency in physical activity.

 

Booth's primary focus was on the notion that physical activity increased muscle mass and fuel utilization, improved cardiovascular function, and improved cellular insulin sensitivity while physical inactivity did the opposite.  Given that lower muscle mass, poor cardiovascular function, and poor insulin sensitivity are either seen in or associated with most of the lifestyle diseases seen in Western culture, it is fair to say that all of these factors may play a role in the relationship between Western disease and physical inactivity.  However, current research adds more to the story.

A review from 2010 discussed the relationship between inactivity and an overly sensitive stress response(2).  Recently, the author of that study was able to identify the physiological change in the brain that come with high levels of physical inactivity.  He found that physical inactivity causes a re-wiring in the rat brain.  Specifically, it causes a more dispersive branching of neurons in the rostral ventrolateral medulla(RVLM), an area of the brain that helps control the stress response(3).  The researchers believe this increased branching is what causes the neurons in the RVLM to be more responsive to stress in physically inactive rats.  While this study has not been repeated in humans, it bears to note that increased sensitivity of the stress response, also called increased sympathetic tone, is also found in many of the lifestyle diseases mentioned above and sedentary behavior is also strongly associated with these diseases(4, 5, 6, 7) and the low grade inflammation that accompanies them(8, 9).

There are other avenues within inactivity physiology that apply to health and are worth mentioning.  During aerobic metabolism, reactive oxygen species(ROS), or free radicals, are continuously generated(10).  Free radicals are molecules with an unpaired electron that serve vital roles in cellular function, but react with healthy molecules within the body and cause oxidative stress when not held in check.  Oxidative stress occurs when free radical generation outpaces the ability of the body's antioxidant defense systems to deal with free radicals.  The body's antioxidant pathways donate electrons to free radicals and help keep free radicals at a healthy level.  As I mentioned in this previous blog, prolonged sitting causes changes in genetic expression that reduce antioxidant and anti-inflammatory pathways and reduce insulin sensitivity.  This would increase oxidative stress which is another physiological factor associated with lifestyle diseases.  In addition, increased oxidative stress leads to higher levels of inflammation which are also associated with these diseases.

Some people attempt to head off oxidative stress by taking antioxidants supplements.  The problem with this is that when supplemental antioxidants are taken and they meet up with a free radical, they donate an electron to the free radical which makes the former antioxidant a free radical, albeit a weaker one.  The antioxidants generated by the body's antioxidant defense system, particularly glutathione, are able to donate electrons to free radicals as well as recharge antioxidants that become free radicals as a result of donating an electron.  This makes the body's antioxidant defense system far more powerful than any antioxidant you can take orally.

What makes this avenue of inactivity physiology particularly interesting is that recent evidence has shown that the average daily energy expenditure of Hadza hunter gatherers is the same as Westerners when controlled for body size despite the physical activity level of the Hadza being greater(11).  Since a person at rest is primarily utilizing aerobic metabolism, it is safe to assume that both groups are either generating the same number of free radicals or the Westerners are generating more based on their larger size alone.  On top of this, the increased level of sedentary behavior associated with the Western lifestyle could potentially induce higher levels of oxidative stress through a reduction in antioxidant gene expression while the physically active lifestyle of the Hadza may promote health by keeping free radical levels at an appropriate level.  Since the Western lifestyle diseases discussed earlier are also associated with high levels of oxidative stress and hunter gatherers like the Hadza rarely experience them, it makes you wonder if shutting down these pathways contributes to the Western lifestyle diseases.  In other words, a deficiency in physical activity may in fact be a strong contributor to the lifestyle diseases that are prevalent in Western cultures for many physiological reasons.

The Human's guide to being human: Physical inactivity and prolonged sitting

People often take a couple of hours out of every week to get in some form of exercise.  The recommendation by most health authorities is that people should perform at least 150 minutes of moderate to vigorous physical activity (exercise) per week to maintain a healthy body.  When you look at the literature, this seems like pretty good advice.  However, there is a problem that isn't typically addressed by these recommendations that is equally, if not more, important.  Does exercising for 2.5 hours per week adequately address the needs of a person who sits for 8-12 hours per day.  When you take a look at the literature, it appears that this is not the case.

Are inactivity and exercise points on a continuum?

Over the last couple of decades, researchers have been trying to identify whether being inactive and exercising are merely points on a continuum.  If you are inactive for most of the day, can adding in some moderate to vigorous physical activity average out that inactivity and improve the negative effect you get from sitting all day long?  Most of the epidemiological data shows that exercising is healthy and reducing sedentary time is healthy, but are they both just manipulation of the same physiological response?

The problem with using epidemiological data to determine something like this is that when someone engages in one form of health promotion such as exercise, they are more likely to engage in other activities that are health promoting and avoid activities that are health compromising.  In other words, someone who exercises is more likely to also pay attention to their diet and avoid smoking when compared to someone who doesn't exercise at all.  This causes the data to be corrupt because you really can't determine from a questionnaire whether or not the healthy person is seeing an effect from a single healthy activity or from their many healthy activities.  This is why you typically see conflicting data from study to study.

It becomes very difficult to figure out what is healthy when you get so much conflicting data, such is the inherent risk of relying on epidemiological data.  A great case in point is that this study shows that sedentary time is associated with the metabolic syndrome independent of exercise, this study shows that exercise but not sedentary time increases the risk of Type 2 diabetes in at risk people, and this study shows that sedentary time is a better predictor for Type 2 diabetes than exercise time.  If that doesn't make your head spin, those last 2 articles were published a month apart in the exact same journal and essentially say the polar opposite of one another.

Current research suggests a difference between inactivity physiology and exercise physiology

While there is conflict in the epidemiological data, the bulk of epidemiological evidence coming out now point to exercise and reducing sedentary time both being important for health, but for different reasons(1).  In other words, moderate to vigorous exercise does not offset sitting down all day because they work through different channels.  This has directed researchers to observe the effects of sitting time and exercise on how genes are expressed in animals, which has confirmed that there is a difference between exercising and reducing sedentary time, particularly with the way fats are metabolized in the body(1, 2, 3, 4).  Further research in humans has confirmed these results and identified a few other potentially important cellular responses to high levels of sedentary time.

The amount of time people spend being sedentary has been associated with poor health and obesity, primarily through higher levels of inflammation(5, 6).  As mentioned in Evidence against the Western Lifestyle, three conditions that are associated with every chronic disease are chronically high levels of inflammation, high blood glucose levels, and high levels of oxidative stress.  Since the epidemiological data is conflicting but animal studies have shown that inactivity physiology and exercise physiology are different, studies in humans have been conducted to determine what happens when humans sit for prolonged periods of time.

Inactivity and changes in gene expression

One of these studies found that sitting for prolonged periods of time without getting up induced changes in gene expression that negatively impacted glucose regulation as well as antioxidant and anti-inflammatory pathways(7).  When people broke up these periods of inactivity by getting up and walking around, a positive response in gene expression was seen.  Another study looking at the effect of loading one leg while causing the other leg to be unloaded showed that the expression of genes in each leg was different, with the unloaded leg showing the less desirable pattern of gene expression(8).  This poor pattern of gene expression persisted even once the unloaded leg was reloaded again.

Since these studies are not comparing people who exercise but are mainly sedentary to those who don't exercise but are on their feet most of the day, they cannot be used to say that there is a significant difference between the two conditions.  At this point there is no perfect study such as that to prove one way or another whether exercise makes up for being seated all day long.  However, there is evidence that reducing sedentary behavior and performing exercise lead to different physiological outcomes.

Lipoproteins in inactivity and exercise

A study looking at blood lipids found that reducing sedentary time improved VLDL-P, LDL-P, and triglycerides while exercise had no effect.  Exercise had an effect on HDL-P, HDL size, Apo A1, and total HDL-C while reducing sedentary time had no effect(9) on these variables.  All of these variables are related to how fat and cholesterol are carried in the blood and metabolized, and this evidence points to there being distinct benefits from reducing sedentary behavior and performing exercise that do not overlap with one another.  Another study backed up this evidence by showing that 1 hour of exercise did not compensate for the negative changes in glucose handling and blood lipids caused by sitting the rest of the day despite both groups burning the same total number of calories(10).

Another study that compared the effects of sedentary time to exercise found that levels of interleukin 6(IL-6) were affected by reducing sedentary time independent of whether the person exercised or not(11).  This is an interesting finding because high levels of IL-6 are a very strong risk marker for the diseases associated with chronic levels of inflammation(12).

Conclusion

These studies point to there being a difference between inactivity physiology and exercise physiology.  On top of their effect on overall health, high levels of inflammation and altered lipid metabolism will also negatively impact your ability to burn fat.  Many people like to push exercise as the end all be all in fat loss, but these studies suggest otherwise.  There is also a fundamental flaw in the logic that 1-2 hours of exercise 5-6 days per week can make up for being sedentary all of the time.  Sitting down all day long and running or strength training for a couple of hours should not be considered the default condition because it is not the condition we evolved in and were selected for.  The condition we evolved in would have included very little sitting time, walking 5-7 miles per day, and intermittent bouts of intense to moderately intense exercise when necessary.  While just a couple of years ago it was believed that sitting down all day long and exercising were merely a continuum, the bulk of the evidence out today points to reducing sedentary time and exercising being physiologically different from one another.  This does not mean one is more important than the other, but if you are doing one or the other and not seeing the results you would like to see from your wellness plan, start working on the other variable.

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Prolonged sitting may actually cause your fat cells to expand...mechanically

We all know that people need to sit down less and move around more.  When most people think about the reason why sitting all day will cause their butt to get bigger, they break it down to burning too few calories and taking in too many.  There are actually quite a few reasons why this happens, many that have to do with genes.  Researchers just found a new one that may seem a little cooky.

By analyzing the way cells respond to forces applied to them, researchers were able to determine that when fat cells are exposed to chronic pressure, they begin to accumulate lipid droplets at an accelerated rate.  In layman's terms, this means that sitting on your butt all day long will cause the fat cells located there to grow bigger due the weight you are putting on them, not just because you are eating more calories than you are burning.  This is in direct contrast to the effect sitting has on muscle and bone cells, which causes a reduction in those cells.

Other environmental factors are at play here. In this blog I discuss how prolonged periods of sedentary behavior create environmental changes within the body that cause your cells to change in a way that promotes higher blood glucose, triglycerides, inflammation, and other changes that are associated with obesity.  As you can see, people become obese for many reasons, not just because they eat more calories than they burn.  They are promoting an environment that causes their cells to respond in a way that makes that person obese.  Energy balance certainly has a place at the table in this discussion, but it doesn't have the only place.  Looks like we can add a place for prolonged physical loading at the table now too.

Product Revew: Fitbit One

What: Fitbit One Activity Tracker

 How much: $99.95

Where: Best Buy or online at Fitbit.com

Overview: A major upgrade to the Fitbit Ultra at the same price point.  The silent alarm and new dashboard are also much improved.  They've also fixed the bluetooth syncing for the Iphone 4S and 5.

Features: Directly tracks steps, flights of stairs, calories, sleep, and functions as a vibrating alarm.  You can also track much more data including blood pressure, blood glucose, workouts, diet and a lot of other variables on the dashboard at fitbit.com or on your iphone 4S or 5, or Ipad 3. 


Review: I was a big fan of the Fitbit Ultra when it fist came out so I was excited when the Fitbit One became available at the beginning of the year.  Not only is the new design sleeker, but the whole user experience has been improved with the Fitbit One.  For those of you not familiar with activity trackers, they are far more sophisticated than a pedometer.  While the device itself is really cool and worth the price, the greatest benefit of the Fitbit One is the dashboard located at Fitbit.com, but more on that later.

The Fitbit One is very easy to set up and get started.  You simply download the Dashboard software from the website and plug the wireless dongle in to a USB port on your computer.  Syncing the One is as easy as being motionless within 15ft of the computer you have the dongle plugged in to.  The One also has an onboard battery so you need to remember to charge it every 7-10 days.  The Fitbit Ultra definitely had a longer battery life but it also had a more archaic display and the bluetooth syncing didn't work as well.

Another new feature on the Fitbit One is the device itself.  The Ultra came with a belt clip but could attach directly to your belt without a clip.  The Fitbit One must be used in the rubberized clip if you want to attach it to a belt or bra and is water resistant, but not really waterproof.  I dropped the One in a glass of water (On accident of course) and it worked perfectly fine, and I don't see sweat being an issue as it could be with the Utra.  The sleep function appears to be exactly the same as the Ultra, but the One sports a silent alarm that is so much better than waking up to a blaring radio or annoying buzzing sound.

As mentioned above, the dashboard is where the Fitbit One shines.  There are many features and extra data points you can put in through the dashboard.  I see many ways that you can use the One and dashboard to help with a variety of problems.  In particular, people with food sensitivities or allergies who are keeping a food journal can follow the effects certain foods have on their sleep, energy levels, blood pressure, blood glucose, subjective feelings, and even more.  Below is a screen grab of the Fitbit Dashboard.

 

Scrolling over and clicking on each variable allows you to see that variable in more depth.  There is so much information that you can use from the dashboard that I will devote a future blog post on how you can use some of this specific data to help improve your personal wellness program and make positive lifestyle changes. In addition to the data, you can also form groups and compete in challenges with one another.  We have a Synergy Wellness Paleo Challenge Group where we compete in different challenges to motivate one another.  Starting this fall we will begin an 8 week challenge that anybody is welcome to join provided they have a Fitbit device.

So what are the problems with the Fitbit One?  I have yet to find something glaringly wrong with the product and feel that it is worth the extra $40 to go with the One over the lower end model Zip.  Obviously the sleep function cannot determine whether you are in deep sleep or just being still, but I still think that data can be useful.  As is the problem with most of the Fitbit products, it takes a while to get used to taking it off of your clothing.  This can lead to problems with losing the device or throwing it in to the wash on accident.  I have had clients who have accidentally thrown their Fitbit in to the wash and customer service has been good about replacing them. 

The Bottom Line: I highly recommend the Fitbit One to anyone trying to live a healthy lifestyle.  I also highly recommend that trainers and people running corporate wellness programs get their clients in on the action.  It not only provides a level of accountability that people can't slip out of, it also provides motivation through challenges and allows people to identify lifestyle factors than can work against achieving their goals.

Conquering Type 2 Diabetes: Lifestyle

When trying to overcome Type 2 diabetes, lifestyle modification trumps medicine most of the time.  If you have done so much damage that there are not enough beta cells in your pancreas to make insulin you may be dependent on insulin for life, but you can still limit the amount of insulin you need via lifestyle modification.  In the previous blog on diet we went over why you should avoid processed foods and eat plenty of fruits and vegetables to help promote good gut bacteria and a healthy intestinal lining.  In this blog we will cover other lifestyle factors that impact blood glucose control.  These factors can be broken down in to three primary categories: Sleep, physical activity, and stress management.

Sleep

Sleep is incredibly important for human health and insufficient sleep duration and/or quality can have a major impact on your health.  A study published in 2013 found that insufficient sleep affected the expression of 711 genes that help modulate the stress response, immune system, and metabolism(1).  The study found that 1 week of sleep restriction of slightly less than 6 hours per night lead to a host of problems at the genetic level including increased oxidative stress, altered circadian rhythm, and altered energy metabolism, three hallmarks of many of the chronic diseases we see today including Type 2 diabetes.  This study is a fairly good representation of the sleep habits of many Americans as a good chunk of the population gets less than 6 hours per night(2).  Other studies have found that restricted sleep lead to changes in glucose regulation, insulin sensitivity, and leptin sensitivity(3, 4).  These changes begin to occur in as little as 2 nights of restricted sleep and a single night of no sleep(Hear that night shifters?).  Typically, the progression of Type 2 diabetes begins with leptin resistance followed by insulin resistance.  Over time, blood glucose regulation becomes permanently affected and Type 2 diabetes ensues.  The research on sleep and Type 2 diabetes is pretty much settled at this point, not getting good quality sleep for 8 hours dramatically increases your risk for Type 2 diabetes(4).

Physical Activity

When most people think of physical activity they think of exercise.  This is a mistake, because an hour of exercise per day cannot make up for prolonged sedentary time in helping prevent Type 2 diabetes and the metabolic syndrome(5, 6, 7).  Even just breaking up prolonged periods of sitting with 2 minutes of physical activity every 20 minutes helps improve glucose metabolism(8).  Most of the data points to spending as little time per day sitting being more important than exercising.  Certainly exercise is also important, but try standing more throughout the day first.

Next, walking more throughout the day is also something that is very beneficial in preventing and reversing Type 2 diabetes.  Aside from the benefits of not being sedentary, taking a 15 minute walk after each meal has been shown to decrease the risk of Type 2 diabetes(9).  Furthermore, people who maintain their daily step count over 5 years have been shown to maintain their insulin sensitivity better than people whose daily step count decreased over that time(10).  A good goal to shoot for and the recommendation by the American Heart Association is 10,000 steps per day.  The average American tends to get about 6600, quite a bit lower than the recommended number.  Just taking a 15 minute walk after each meal will give you 4500 steps, so it's not that difficult to accomplish.

Stress

Physical inactivity can also lead to changes in the brain that can modulate the stress response in a negative way(11).  In addition, sleep restriction can cause an overactive stress response(1).  To complete the circle, sleep restriction in the face of physical inactivity has been shown to negatively impact insulin sensitivity and blood glucose regulation(12).  All three of the factors we have discussed today are interrelated when it comes to the risk of Type 2 diabetes.  While it may be easy to put yourself to bed early or make sure you get enough daily steps in, managing stress is a completely different ballgame. Fortunately, doing the other two usually helps with the third.

It's very easy to see the importance of the stress response when it comes to physical stress.  When you are out in the jungle and about to become a lion's lunch, the stress response springs in to action to partition your resources for fight or flight.  This puts all non-essential processes on hold and floods the body with stress hormones.  The stress response begins and ends in the hypothalamus.  In what is basically a game of hormonal telephone, the hypothalamus tells the pituitary gland to tell the adrenal glands to make stress hormones.  These hormones help mobilize energy, particularly glucose, to provide the body with fast acting energy.  Over time, these hormones act on the hypothalamus and tell it to cools it's jets.  Obviously mobilizing energy is key to fighting or fleeing, the problem is that there is a direct line from the amygdala to the hypothalamus and that can turn on the stress response in the face of a perceived threat.

The amygdala is the emotional center of the brain.  Under the proper circumstances, the amygdala can tell the hypothalamus to initiate the stress response.  The problem is that in today's society, there are so many psychological stressors that can initiate the stress response.  How am I going to pay the mortgage?  What if my wife divorces me?  I have a big deadline that I need to make.  Any sort of situation that we deem as stressful has the potential to initiate the stress response.  The problem is, what do you need energy for to flee an emotional stressor?  Furthermore, can you ever really flee an emotional stressor?  Even if you do, there is typically another one right behind it.  As these stress hormones and glucose enter your bloodstream, there really is no need for them because it's not energy that you need.  What you need is to stop processing this information through your amygdala.  This is the goal of mindfulness.

The reason you have been hearing so much about mindfulness and mindfulness meditation is because mindfulness is a way to alter your thought processing so that you avoid generating an emotional response to psychological stress.  Many companies have begun mindfulness meditation programs as a way to help reduce stress for their employees and top executives tout it's benefits in helping them deal with stress.  How does this relate to Type 2 diabetes?  People with Type 2 diabetes have increased sympathetic nervous system activity(13).  This basically means that their stress response is activated more often and more easily than a normal person.  This flood of stress hormones and blood glucose is not good when it isn't needed.  Just to get a firm grasp on how important the stress response is in Type 2 diabetes, one of the ways that the stress response increases blood glucose is by causing the liver to produce more of it.  One of the primary pharmaceuticals used in Type 2 diabetes is metformin and it's mode of action is...It causes the liver to make less glucose.

Developing good stress management tools is key to helping prevent or reverse Type 2 diabetes.  Mindfulness is probably the best tool out there and can provide a one-two punch combined with proper sleep to help manage stress and help prevent or reverse Type 2 diabetes.  Add in a little physical activity to make you tired, and you have a pretty good jump start on living a healthier, Type 2 diabetes-free life.

Conclusion

There is tons of research on the aspects of lifestyle that will negatively impact blood glucose regulation and increase your risk for Type 2 diabetes.  Getting enough sleep, partaking in  regular physical activity, and managing stress are all important in preventing Type 2 diabetes as well as managing your blood glucose if you have it.  Making an effort to get 8 hours of sleep every night, getting at least 10,000 steps a day, spending as little time as possible being seated/sedentary, and utilizing stress management strategies such as yoga and practicing mindfulness should be on your to-do list if you want to live a long, healthy, happy life free of Type 2 diabetes.

Part 1-Overview
Part 2-Diet

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. 

Feel fat, depressed and unhealthy? Get off your tookus!

If you're like most people, you spend your entire day at a desk and 3-4 hours a week at a gym trying to combat the negative effects associated with sitting at that desk.  As time has gone on, you've probably also noticed a reduced ability to maintain your body weight as well as increased risk markers for cardiovascular disease and other chronic diseases.  Even when you double up the amount of time you exercise per week for your New Years' resolution your results get worse each year, leading to year over year increases in fat mass.  The reason this happens is not because you don't exercise enough, it's because you spend too much time sitting.  Sedentary behavior leads to modified genetic expression that promotes fat gain and cardiovascular disease, and no amount of exercise at a gym will prevent that.  When you look at the grand scheme of things, even if you exercise intensely for 16 hours a week that still leaves 152 hours per week where the wrong genes are turned on.  Don't believe it?  Let's take a look at some of the research.

High levels of sedentary behavior are associated with the metabolic syndrome, independent of other factors related to the metabolic syndrome including moderate to vigorous physical activity(Alcohol intake, smoking status, age, gender, diabetes and heart disease)(1, 2).  This means that getting physical activity via exercise did not compensate for the amount of time spent being sedentary.  The amount of sedentary time also has a strong positive relationship with triglyceride levels as well as waist circumference and waist to hip ratio.  High levels of sedentary time also lead to higher circulating levels of insulin(3, 4, 5, 6, 7, 8), impaired glucose clearance(3, 7, 8)  and impaired fatty acid metabolism(5, 7, 8).  While a couple of these studies were done with people on multiple days of bed rest and therefore not directly comparable to people sitting at a desk day in and day out, most of these changes with insulin action and glucose appear to be a result of changes in localized gene expression due to a lack of muscular contraction(7).  In fact, as discussed in Part 2a of my 3 part series "Myths, Metabolism, and Appetite" (Part 2a), it may actually be whether or not the leg is loaded, regardless of muscular contraction.  Unloading one leg while still allowing movement of that leg for 48 hours leads to altered genetic expression that increases protein breakdown and anti-oxidant pathways (Indicating increased oxidative stress) while reducing mitochondrial metabolism with no change in gene expression in the other leg(9).  This reduction is mitochondrial metabolism is probably the mechanism by which fatty acid metabolism is reduced during sedentary periods.  These changes persisted even after 24 hours of reloading the leg.

When we look at who is most affected negatively by sedentary behavior from an insulin sensitivity perspective, it appears that healthy people are more negatively impacted than people prone to Type 2 Diabetes (T2D).  In a study that looked at bed rest and changes in insulin sensitivity with healthy people as well as people with first degree relatives with T2D (FDR)and those with low birth weight, two risk factors for T2D, the healthy subjects experienced a greater drop in insulin sensitivity (5).  The authors hypothesize that this effect is due to the other two groups already having some degree of insulin resistance. In another study comparing insulin sensitivity changes in healthy subjects to FDR, whole body insulin sensitivity declined in both groups but hepatic (Liver) insulin sensitivity declined only in the FDR group.  This is interesting because as discussed in "Myths, Metabolism, and Appetite", people who are prone to T2D and FDR of T2D have fewer type I fibers and a higher proportion of type IIx muscle fibers.  This is, in part, a gene environment interaction.

While the more oxidative (Fat burning) type I fibers have not been shown to convert to other fiber types, the more glycolytic (Glucose burning) type IIa and IIx fibers tend to convert back and forth based on recruitment of said fibers.  Lack of use causes IIa fibers to convert to IIx fibers which are more insulin resistant while regular recruitment of IIx fibers causes them to convert to IIa fibers.  In people with a higher percentage of type II vs. type I muscle fiber types that also do not recruit these fibers regularly, most will become insulin resistant as more of their musculature converts to the insulin resistant type IIx fibers.  People with this genotype probably have to participate in regular strength training to recruit the insulin resistant IIx fibers enough so that they convert to the less insulin resistant IIa fibers, particularly if they intend to consume a high carbohydrate diet.  Coincidentally, converting IIx fibers to IIa fibers allows these people to store more muscle glycogen.  Emptying out these glycogen stores with regular, intense strength training will provide a larger storage compartment for ingested carbohydrate and delay hepatic insulin resistance.  Ironically enough, people with this genotype tend to be the better power sport athletes so it seems that modern life is just not compatible with this genotype.  My guess is they would also have been the best hunters which could indicate why such a high percentage of the population is prone to T2D from an evolutionary perspective.

Another interesting aspect of sedentary behavior is it's effects on lipoprotein lipase(LPL) activity.  LPL is an enzyme responsible for triglyceride breakdown.  Reduced LPL activity leads to higher blood triglycerides via a reduced ability to metabolize fat.  Obviously conditions that lead to a reduction in LPL activity are not ideal, especially if one of your goals is to reduce body fat.  Sedentary behavior has been shown to dramatically lower LPL activity (6, 7) in the muscles of the leg and reducing sedentary behavior has been shown to have a greater effect on increasing LPL activity than does adding vigorous physical activity (7).  This increase in LPL activity makes sense because the muscle fiber type associated with physical activity of lower intensities is the type I fibers that tend to rely more on fat as a substrate.  As the intensity of your exercise increases, so does the utilization of glucose as fuel to power the type II fiber types during that activity.  During both active and passive recovery there appears to be a switch to the type I fibers and a greater reliance on fat as fuel, perhaps to spare glucose for future intense activity.

Other genes and pathways associated with health are positively affected by breaking up periods of inactivity.  One study identified 75 different genes differentially expressed during periods of inactivity vs. periods of activity used to break up inactive periods (8).  Many of these genes are involved in processes that are known risk factors for cardiovascular disease.  Breaking up periods of inactivity with periods of physical activity for 2 minutes every 20 minutes positively affected the expression of genes associated with carbohydrate metabolism, antioxidant pathways and anti-inflammatory pathways.  Another study found breaking up periods of inactivity improved postprandial insulin and glucose concentrations when compared to a completely sedentary condition(9).  While we have focused much of our attention on the localized effect of sedentary behavior on muscles and to a lesser extent the liver, there also appears to be a significant negative impact on the brain.

Increased sympathetic nervous system activity is a widely known symptom of obesity and T2D.  The autonomic nervous system is in charge of regulating mostly involuntary processes and has two branches.  The parasympathetic branch is responsible for rest and digest while the sympathetic nervous system is responsible for the fight or flight response.  People with increased sympathetic nervous system activity have a problem getting out of stress mode, in other words they are in a constant state of stress.  Research indicates that this increased sympathetic activity may be mediated by dysfunction in a part of the brain called the rostral ventrolateral medulla (RVLM)(10).  The RVLM is the primary part of the brain involved in regulating sympathetic nervous system activity.  Physical inactivity may have wide-ranging negative effects on the RVLM and this could explain the detrimental effects of sedentary behavior on measures of cardiovascular disease regulated by the autonomic nervous system such as hypertension.  It is not known at this point if the difference between sedentary and active people is due to a negative effect of being sedentary, a positive effect of being active, or a combined effect of the two.

As you can see, being in a seated position for prolonged periods is a significant factor in poor health and an inability to metabolize fat.  While insulin sensitivity and blood glucose utilization are two big factors impacting both, these are not the only considerations.  The data suggests that sitting for long periods of time is terrible for your health and no amount of exercise at the gym can attenuate the bad effects of sitting.  These effects may expand beyond the physical changes happening in the muscles and more than likely has deleterious effects on the brain.


EDIT: After I wrote this I found a new randomized clinical trial that looked at 3 groups (sedentary, sedentary+1 hour of intense exercise, and a group that spent half the time being sedentary and the other half standing or doing low intensity activity).  Guess who "won".  :)

Check it out.

http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0055542