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Obesity
Protocol
Food
Fraud
In spite of the term "low-fat" or "fat-free" appearing
on more and more food labels, a record number of Americans are overweight.
The problem is that "low fat" often means "high sugar."
For example, look at the label of fat-free salad dressings; they are
loaded with sucrose or fructose.
Sugar
is cheap and is a palatable alternative to oils that add fat calories.
For instance, when looking at pasta sauce labels, you will see that
the majority of them are loaded with "high fructose corn syrup"
or just plain old sucrose. Eating these sugar-fortified sauces with
high glycemic pastas and bread can create an enormous insulin spike.
Fruit
and vegetable juices feature healthy-looking photographs on their labels,
but when looking at the calorie content of these sugar concentrates,
you should seek to consume the actual fruit or vegetable in lieu of
the juice. Even products that purport to have health benefits such as
tea beverages are often loaded with sugar.
Food
companies have duped Americans into believing that anything that is
low in fat is beneficial. Consumers should carefully read food labels
to make sure they are not inadvertently loading up on insulin-spiking
sugar calories.
When
addressing the problem of high-glycemic diets, there are two obstacles
to overcome. First is to cut the craving for sugar; the other is to
change eating patterns to reduce intake of high-glycemic foods late
in the day.
The
solution is to regulate insulin secretion in such a way that both late-day
carbohydrate craving and excessive calorie intake is reduced.
AppendiX D
Risks
Gastric Surgery
One of the latest developments in treatment of obesity is the use of
surgery to restrict food intake or to interrupt normal digestive function.
These techniques are usually reserved for the severely obese, with a
body mass index over 40, which corresponds to about 100 pounds overweight.
There
are two surgical methods for weight loss: gastric banding and gastric
bypass. In gastric banding, the amount of food the stomach can hold
is reduced by closing off or removing parts of the stomach. A gastric
bypass procedure reduces the digestion and absorption of food by connecting
the stomach to the lower part of the small intestine, bypassing the
duodenum and some of the jejunum.
Restrictive
operations lead to weight loss in almost all patients, although some
are unable to adjust their eating habits and fail to lose weight. About
30% of persons undergoing vertical banded gastroplasty achieve normal
weight and about 80% achieve some degree of weight loss.
Gastric
bypass operations are usually combined with restrictive operations to
increase the effectiveness. Patients who have bypass operations generally
lose two thirds of their excess weight within 2 years.
Risks of Surgery
In 10%-20% percent of patients who have weight-loss surgeries, follow-up
surgeries are required to correct complications. Abdominal hernia is
the most common complication requiring follow-up surgery. Less common
complications include breakdown of the staple line and stretched stomach
outlets.
More
than one third of obese patients who have gastric surgery develop gallstones.
Gallstones are clumps of cholesterol and other matter that form in the
gallbladder. During rapid or substantial weight loss, a person's risk
of developing gallstones is increased. Gallstones can be prevented with
supplemental bile salts taken for the first 6 months after surgery.
Nearly
30% of patients who have weight-loss surgery develop nutritional deficiencies.
Decreased absorption of vitamin B12 can cause anemia, and decreased
calcium absorption can cause osteoporosis and metabolic bone disease.
These deficiencies can be avoided if vitamin and mineral intakes are
maintained.
Gastric
bypass operations may also cause "dumping syndrome," in which
the stomach contents move too rapidly through the small intestine. Symptoms
include nausea, weakness, sweating, faintness, and occasionally diarrhea
after eating, as well as the inability to eat sweets without becoming
so weak and sweaty that the patient must lie down until the symptoms
pass.
AppendiX E
Different
Causes of Obesity
Obesity is most often attributed to increased intake of calories combined
with a decreased output of energy. There are other clinical entities
that might be the underlying cause or contributory factors of weight
gain (Collins 1981; Healey et al. 1994; Bouchier et al. 1997):
Hypothyroidism
(low thyroid hormone)
Adrenal disease, including adrenal insufficiency, Addison's disease
(adrenal deficiency), and Cushing's syndrome (adrenal excess)
Pancreatic problems, including diabetes, insulin insensitivity (Syndrome
X), and insulinoma (insulin stimulates appetite)
Pituitary deficiency, including hypopituitarism (Frolich's syndrome),
hyperprolactinemia, and Nelson's syndrome
Ovarian problems, including polycystic ovary syndrome (excess androgens,
especially testosterone) and postmenopause
Inflammation caused by chronic infections, including meningitis, encephalitis,
tuberculosis, or syphilis
Genetic disorders, such as Klinefelter's syndrome, Prader-Willi syndrome,
Laurence-Moon-Biedl syndrome, Alstrom syndrome, Morel syndrome, Morgagni
syndrome, Morgagni-Stewart-Morel syndrome, Cohen's syndrome, or Carpenter's
syndrome
Excess fluid retention from cardiac, liver, or renal failure, nephrotic
syndrome, periodic edema, or hyperproteinemia states
The use of drugs such as glucocorticoids, tricyclic and heterocyclic
antidepressants, monoamine oxidase inhibitor anti-depressants, lithium,
phenothiazides, sulphonylurea agents, estrogens, and cyproheptadine
(Bernstein 1987)
Cessation of cigarette smoking and alcohol excess (pseudo-Cushing's)
are highly associated with weight gain (Yarnell et al. 2000)
A common cause of obesity in women is Polycystic Ovary syndrome (PCOS).
Until recently, PCOS was very hard to diagnose and even harder to treat.
With modern ultrasound diagnostic technology and the advent of aromatase-inhibiting
drugs and metformin (Glucophage), some physicians have achieved a high
degree of success in treating this condition.
Overweight
subjects also are uniformly deficient in growth hormone and its cleavage
fractions including IGF-1. We believe this to be the result of deficient
production of growth hormone releasing factor by the hypothalamus, all
of which is related to obesity.
AppendiX F
Basic
Dietary Information
Basal
Metabolic Rate
Calculating the Insulin/Glucose Ratio
Calories A calorie is the amount of heat energy required to raise the
temperature of 1 milliliter of water at a standard initial temperature
1 degree centigrade. Large amounts of energy are released during the
digesting of food. A capital letter (K) is often used with "calorie"
to denote kilocalories (1000 calories). For practical application, the
following are the energy content of each of the categories of food:
Carbohydrates
contain 4 kilocalories per gram.
Protein contains 4 kilocalories per gram.
Fat contains 9 kilocalories per gram.
Alcohol contains 7 kilocalories per gram.
Basal
Metabolic Rate
When a body is totally at rest, the amount of energy spent carrying
out activities necessary to sustain life (such as respiration, circulation,
etc.) is called the basal metabolic rate (BMR). When calculated over
24 hours, the average BMR is
1680
kcal for the average 70-kg (154-pound) man
1173 kcal for the average 58-kg (127.6-pound) woman
The process of digestion greatly impacts the basal metabolic rate because
it requires energy. This energy expenditure is called diet-induced thermogenesis.
Fats and carbohydrates increase the BMR by about 5%. An all-protein
diet increases the metabolic rate by 25%. A mixed or balanced diet increases
the BMR by 10%. However, severely restricting calories reduces the basal
metabolic rate, thereby causing fatigue (from a decreased level of overall
energy) and eventual weight gain. That is why thyroid hormone replacement
is so important in many people who are going to restrict their calorie
intake in order to lose weight. Adequate thyroid hormone status maintains
the basal metabolic rate.
Calculating the Insulin/Glucose Ratio
We cannot stress enough the role of insulin in causing and, even more
important, maintaining obesity. As little as one (1) microUnit of insulin
in the blood prevents the release of any fat from storage, no matter
how little is eaten! We are often asked how to tell if one is hyperinsulinemic.
The simplest method to determine if you are hyperinsulinemic is to have
your fasting insulin levels tested. This means you cannot eat anything
for 12 hours prior to having your blood drawn. Most people have their
blood drawn in the morning and achieve the 12-hour fast by skipping
breakfast. Optimal fasting insulin levels are between 0-3.
Another
way of assessing serum insulin levels is to have blood drawn for serum
glucose and serum insulin levels at the same time. When the results
are obtained, multiply the glucose number (reported in milligrams percent)
by 0.41 and then subtract 34. The resulting number is what your insulin
level should be (reported in microUnits).
0.41
× Glucose (mg%) minus 34 =
Insulin (microUnits)
AppendiX G
Calorie
Restriction
Over 60 years ago, scientific experiments showed that dietary restriction
dramatically increased the life span of rats, as compared with those
that were allowed to eat as much as they wanted. One theory is that
short-term caloric restriction stimulated an adaptive response to famine
that shifted resources away from reproduction and toward self-repair
to maintain life. This may involve a change in gene expression that
stimulates the production of "stress proteins" and other protective
mechanisms (Shanley et al. 2000; Mattson et al. 2001; Van Remmen et
al. 2001).
The
study of the genetic changes induced by calorie restriction has been
the focus of extensive research by Dr. Stephen Spindler. Using advanced
gene chip technology, Dr. Spindler was able to examine changes in 11,000
genes, including most of the genes involved in DNA repair, antioxidant
metabolism, and protein synthesis (Lee et al. 1999).
Moderate
calorie restriction has been shown to stimulate several anti-aging mechanisms,
including:
Inhibiting
programmed cell death (apoptosis) (Mattson et al. 2001)
Increasing protein synthesis and turnover (Lambert et al. 2000; Weindruch
et al. 2001)
Increasing the production of antioxidant proteins resulting in less
oxidative damage (Sohal et al. 1996; Lass et al. 1998; Zainal et al.
2000)
Stabilizing cellular calcium homeostasis (Mattson et al. 2001)
Increasing the secretion of growth hormone (IGF-1) to normal levels
(Sonntag et al. 2000)
Increasing the resistance of neurons in the brain to dysfunction and
increasing the number of newly generated neural cells in the adult brain
(Mattson 2000)
The effects of a calorie-restricted diet on humans were inadvertently
conducted on the 4 men and 4 women that lived in Biosphere 2 for 2 years.
On the low-calorie, nutrient-dense diet, the men sustained 18% weight
loss and the women sustained 10% weight loss, mostly within the first
6-9 months (Walford et al. 1999).
AppendiX H
Body
Fat Measurement
The Medical Examination
A well-trained medical physician should be consulted before beginning
a weight-loss program. Your physician may do the following:
Take
a careful medical history and perform a physical examination.
Inquire about your personal weight history, how long you have been overweight,
and methods you have used to lose weight in the past.
Ask whether you have relatives with illnesses related to overweight,
such as Type II diabetes mellitus or heart disease.
Evaluate your risk for obesity-related health problems by measuring
your blood pressure and performing blood tests.
If your physician determines that you have obesity-related health problems
or are at high risk for such problems, and if you have been unable to
lose weight or maintain weight loss with non-drug treatment, he or she
may recommend the use of prescription weight-loss medications. If your
physician is considering using a prescription weight-loss medication,
it is important to inform him or her of any of the following medical
conditions:
Pregnancy
or breast-feeding
History of drug or alcohol abuse or eating disorders
History of depression or manic depressive disorder and use of monoamine
oxidase (MAO) inhibitors or antidepressant medications
Migraine headaches requiring medication
Glaucoma or diabetes
High blood pressure, heart disease, or other heart conditions, such
as an irregular heart beat
Plans for surgery that require general anesthesia
Body
Fat Measurement
The amount of total body fat can be estimated in several ways:
One
simple method is to measure waist circumference at the midpoint between
the lower border of the ribs and upper border of the pelvis. The waist
to hip ratio is calculated by dividing this measurement (in centimeters)
by the circumference of the hips. This is a simple method of measuring
abdominal obesity, although it is not very accurate in predicting actual
abdominal fat.
Skinfold thickness can be measured using specialized calipers. The most
common sites to measure are on the arms, legs, back, and abdomen. This
method provides more information than the waist to hip circumference,
but measurements are often variable, depending on the observer.
Bioelectrical impedance measures body electrical conductance and resistance.
Electrodes are placed on the hands and feet and are connected to a special
electronic instrument. This method is based on the difference in electrical
conductance between fat, lean body mass, and water. This method is simple
and practical.
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