August 2007

Q. How do your theories in The Body Shape Solution to Weight Loss and Wellness correspond to this recent Framingham Study on diet soda?

A. In the book, I caution against drinking both regular soda (pure sugar with no nutritional value/raises insulin levels and increases hunger in the long run?) and diet soda (not only do we not really know the long term safety of the artifical sweeteners/think of trans fats and although we thought a safe substitute for butter at first, now know they are MUCH more dangerous - diet drinks have shown in other studies as well to lead to weight gain!!) Although no one has any certain idea why, there is something about the behavior/environment/diet drink itself that leads the diet soda addict (and they ARE addicts of sorts - just ask them) to eat more and gain more. Do they increase our appetites for other foods? change our metabolism? who knows? just guilt by association??!! In my practice, I always found a link between dieters and heavy diet soda consumption. My own sister who I discuss in the book is hooked on diet soda - always has a diet pepsi in her hand and has a hunger for food on a constant basis.

Q. Do you see an actual direct casual link between the consumption of diet soda and metabolic syndrome? If so, what is it? Or is the link poor eating habits in general?

A. No one understand why it is linked - sugar containing drinks lead to increased insulin which packs on more dangerous visceral fat and leads to increased hunger and viscious cycle of eating. There is something about diet soda - but I suspect it is "guilt by association" as I answered above - but we just don't know. If you are hooked on diet sodas - good time to examine your other behaviors and force yourself to eliminate all white sugar/sweet products, the high glycemic index foods that release way too much insulin. A recent study in May 07 JAMA showed that apple-shaped people (most men are apples, postmenopausal women are apples and some but not most premenopausal women) respond best (more effective and sustained weight loss) to a diet of LOW glycemic index foods, the elite carbs I talk about in my book/i.e. high fiber unprocessed plants are best (fruits/veggies). The fiber delays digestion, slows/dampens the insulin response, less visceral fat, less hunger, etc.and plenty of healthy fats like omega 3 fish and nuts.

Q. So should we all avoid diet soda and caloric sodas altogether? What beverages are recommended for general health and heart health?

A. If you need diet sodas/addicted - then try to drink along with high fiber (unprocessed) fruits/veggies to dampen insulin response (it is likely that diet sodas somehow trigger insulin response or else diet sodas are linked to eating other highly processed sugar foods which are known to trigger insulin response) and add handful of nuts instead of the diet soda. Sounds crazy, but for people with large waist sizes/metabolic syndrome - would advise stop/taper diet and sugar drinks or take with high fiber foods, handful of nuts.

Q. Why does abdominal or visceral fat, as opposed to fat elsewhere in the body, increase potential heart dangers?

A. Fat comes in two main varieties: subcutaneous, which means "under the skin", and visceral which means "pertaining to the soft organs in the abdomen". Subcutaneous fat is the stuff that jiggles, the stuff we hate to see on our bodies. Visceral fat, on the other hand, is not always visible from the outside. It packs itself around the inner organs of the abdomen and sometimes even inside the liver. We all have some visceral fat because it protests our internal organs, acting both as a shock absorber in case of trauma, and as an insulator to help us conserve body heat. Visceral fat is actually living, breathing, hormone-producing, metabolically active tissue deep inside our abdomen cavity - and too much of it gets stored in the liver as well. It provides storage for energy and quickly/readily releases energy/fuel into our blood between meals. Visceral fat helps regulate body functions through the give-and-take of chemical communications with the central nervous system. I tell people to try to think of fat as a gland, as active and important as any other gland in the body. Visceral/Adipose tissues make and release a variety of compounds, including enzymes, hormones (such as leptin, which helps regulate appetite), and inflammation-related chemicals called cytokines. Too much visceral fat leads to rise in c-reactive protein level and other clotting proteins that when in excess cause the metabolic syndrome (high waist size leading to his sugar, high BP, low HDL/healthy cholesterol, and high triglycerides). Although visceral fat and subcutaneous fat are in the same general category, they are totally differeent. Apple-shaped women have more visceral fat, which is more metabolically active than subcutaneous fat, and most of what it does is harmful to the body. Visceral fat decreases insulin sensitivity (making diabetes more likely), increases triglycerides, decreases levels of HDL cholesterol, creates more inflammation, and raises blood pressure - all of which increase the risk of heart disease. Visceral fat releases more of its free fatty acids into the blood stream, further increasing the risk of both diabetes and heart disease. The overall effect of excess visceral fat is that it creates a physical environment that is primed for heart disease and stroke, and greatly increases the risk for certain cancers such as breast and endometrial cancer. The more abdominal fat, the greater the waist circumference, and the higher the WHR, the more dangerous the situation becomes.

Q. Can you explain the "warning signs" that waist size can herald?

A. Basically your waist size (over 31-1/2 inches for women and over 37 inches for men means you are heading toward too much visceral fat. Once you get to 35 for women and 40 for men - you have NUMBER 1 criterion for metabolic syndrome - have dangers beginning. Losing only 2 inches has been shown to reduce risk of metabolic syndrome and diabetes by 60% or more. No pill works this well - lifestyle, predominantly exercise/walking all alone, starts to shrink visceral fat even better than diet for some reason.

Q. What do you wish men and women knew about the apples/pear shape's significance?

A. Grab a tape measure - pay attention to waist size. IF you exceed the numbers above, get copies of fasting blood work, KNOW YOUR NUMBERS, what your BP is, glucose? HDL and TG? Many people are told results are normal - but the combination of BORDERLINE results may add up to this dangerous syndrome that doubles or quadruples your risk of a heart attack and diabetes. Use waist size as early red flag to cut back on diet/other sodas, add fiber, health fats and fish oils to your daily routine - keep track and treat your numbers!!! Well worth it.