Category Archives: Wellness

What is Metabolic Syndrome?

You might have heard the term “metabolic syndrome” and envisioned it as some sort of specific disease, but it’s not quite a “disease” in the typical sense. Metabolic syndrome is better described as a health state in which you are at an increased risk for conditions like diabetes, hypertension, and heart disease.

Metabolic syndrome has been defined in a few different ways. Here are a couple of different explanations:

Depending on how many metabolic risk factors you have, you could be classified as having “metabolic syndrome.” The four health states listed under the NCEP/ATP III definition can be considered as “risk factors” for metabolic syndrome. There are a lot of science-y words in that definition, so let’s break it down.

  • Central obesity: Fat accumulation in the abdominal area, which is particularly associated with obesity and its negative effect on health.
  • Dyslipidemia: Unhealthy levels of lipids (fat) in your body. This could either be too-low levels of “good” HDL cholesterol, too-high levels of “bad” cholesterol “LDL,” or too-high levels of triglycerides (TGs) – a type of fat saved as energy when your body can’t use all of the calories you’ve consumed.
  • Hypertension: It’s basically common knowledge that high blood pressure isn’t a good thing, but why is that again? When you have high blood pressure, it means your heart and arteries are working extra hard to pump blood through the body. Remember, blood carries nutrients and oxygen that all of your cells rely on to survive.
  • Insulin resistance: People develop type 2 diabetes when their cells form a resistance to insulin. Insulin is the hormone that facilitates the use of glucose for energy, so when cells aren’t responding to it, glucose levels in the blood increase. High blood glucose levels cause a myriad of problems, plus it means that your cells aren’t getting the glucose they need.

Mechanisms Behind Metabolic Syndrome

Metabolic changes leading to heart disease, diabetes, and hypertension don’t happen overnight. Lifestyle choices like diet and physical activity levels play a huge role in metabolic syndrome development, but some factors are unavoidable. For example, risk for metabolic syndrome increases with age.

Physiological changes in the body as a result of certain lifestyle choices like poor diet and low exercise levels lead to underlying, systemic inflammation, and oxidative stress. These metabolic changes are what ultimately lead to conditions like heart disease, diabetes, and hypertension.

Prevent or Manage

A healthy diet and active lifestyle can help prevent metabolic syndrome (and a lot of disease, really), but these qualities can also help manage metabolic syndrome if you’ve already started to develop it. Healthy food and physical activity support the liver and help your body better manage glucose.

For example, antioxidants found in micronutrients and phytonutrients like vitamin C, vitamin E, and beta-carotene can address oxidative stress. Antioxidants also promote healthy glucose metabolism and diabetes prevention, and they are associated with reduced risk of heart disease.

Ultimately, the solution here isn’t shocking. Eat healthy food. Be active. Reduce your risk of metabolic syndrome.

(*drops the spinach*)

Advertisements

You, Your Metabolism, and Science: How Research Studies Can Fight the Obesity Epidemic

Note: This is an article I wrote that was originally published on TransformingScience.com.

The one-of-a-kind Human Whole-Room Calorimeter at the UNC Chapel Hill Nutrition Research Institute can be used for a wide variety of research studies. Read on to learn about how this technology works, how experts at the Appalachian State University Human Performance Laboratory are studying metabolism, how these studies are vital for improving human health, and what a typical day as a study participant is like (including getting paid).

ABOUT THE CHAMBER

What they call the Human Whole-Room Calorimeter or Metabolic Chamber is essentially a small room that can calculate how much energy (calories) a person expends (both while resting or moving). This is balanced with the energy taken in through the diet over a 24-hour period. By controlling what you do and what you eat while in the chamber, researchers can accurately measure how much energy it takes to do certain things.

The metabolic chamber at the Nutrition Research Institute (NRI) is equipped with a bed, toilet, and sink. It also has the space to accommodate a treadmill or a stationary bike depending on the requirements of the study being conducted. Research staff can send food and other items through an airlocked compartment, and there are also ports for blood draws if a certain study requires them. There is also a television and – of course – WiFi.

The metabolic chamber is unique; there are only about 26 other similar rooms in the country, and it’s the only one in the Carolinas. This type of technology is essential for researchers who want to study energy balance and fuel use.

The first chamber study was conducted in 2011. The NRI and teamed up with the Appalachian State University (ASU) Human Performance Laboratory, recruiting 10 male participants to test the effect of 45 minutes of vigorous cycling on post-exercise RMR as measured in the metabolic chamber and contrasted with a rest day to determine how much and how long that exercise affected post-exercise energy expenditure. They found that 45 minutes of vigorous exercise resulted in 519 more calories burned compared to the rest day, and post-exercise calorie-burning was significantly elevated for 14 hours, resulting in an additional 190 calories expended, again compared to the rest day.

PARTICIPATING IN A CHAMBER STUDY 

The DEXA

Orientation and baseline testing is the first step of any chamber study. Before your first day in the metabolic chamber, you’ll have a DEXA (Dual-Energy X-ray Absorptiometry) scan done at the NRI as part of your orientation and baseline testing. This machine provides precise measurements of total and regional body composition through high-resolution imaging. However, it is noninvasive and includes very low radiation exposure. Plus, you’ll be able to have a copy of your DEXA results, which include measurements like percent body fat, resting metabolic rate, and bone mineral density.

On your day in the chamber, you’ll arrive at the NRI in the morning between 7:00 and 7:30 to change into (very comfortable) scrubs and take any necessary measurements before entering the chamber around 8:00. Once you’re in the chamber, you can essentially do whatever you want (read, watch TV, use your laptop) as long as you are seated and remain as still as possible. There will always be a monitor on duty if you need anything. Every hour, the monitor will remind you to stand up, stretch, and walk for about two minutes. They will also give you a sheet of paper to take notes about your activity so you can replicate it to the best of your ability on your second visit. To exit the chamber, all you have to do is turn a big red button, and there’s an arrow pointing to it on the wall. Plus, there’s a window inside the chamber that faces the outdoors. No need to get claustrophobic!

View of the chamber from the entrance.

The monitors serve you breakfast, lunch, and dinner, with a snack in between lunch and dinner. Don’t worry at all about getting hungry – the meals provided are tasty and filling. Plus, thanks to the metabolic chamber providing live data, the staff know your calorie needs at all times.

If it’s your exercise day, you’ll run on the treadmill around mid-morning. You rest for 45 minutes after the exercise, then you use sanitary wipes to feel clean again, and you can change into clean scrubs. If the study requires you to take supplements or provide blood samples, the monitors will tell you what to do. In the chamber, there are two intercoms that you can use to communicate with the monitor, one near the treadmill and one near the bed. There’s also a window where you can see the monitor, and a webcam so they can see you. Don’t forget – the toilet is not within view of the webcam and there is a curtain over the window. Your privacy is respected while you are in the chamber! The lights go out for “bedtime” at 10:00, and you sleep (or stay as still as possible when you’re awake) until 6:45 or so. You will be compensated well for your time, even if you complete just one visit.

In studies investigating exercise and energy expenditure, the second day is essentially the same as the first but with one key difference: on this visit you will spend 45 minutes on a treadmill, exerting yourself to 75 percent of your “V02 max,” the maximum amount of oxygen that you use during intense exercise (measured as milliliters of oxygen used in one minute per kilogram of body weight). Before you begin the study, they will test your V02 max by having you run on a treadmill at an incline. In the chamber on your exercise day, it’s a tough workout. But you can do it!

Metabolism studies are important because there is an obesity epidemic in the United States, caused by excessive calorie intake and a lack of physical activity: 69 percent of adults are overweight, with a BMI of 25 or higher, and 35 percent of adults are obese, with a BMI of 30 and higher. Obesity increases the risk of a variety of conditions that are linked to heart disease, including high blood pressure, diabetes, and high cholesterol. Heart disease is the leading cause of death for men and women worldwide.

So by studying the human metabolism, researchers from ASU and the NRI also want to help people effectively and safely lose weight to reach a healthy weight, lowering their risk of heart disease and other complications. Here a few simple recommendations:

  • Eat more carbohydrates and dietary fiber from whole grains
  • Eat more fruits and vegetables
  • Eat less fat to reduce overall caloric intake
  • Engage in physical activity most days of the week, with a total of 150-300 minutes per week

ASU and NRI experts have found that limiting calorie intake – eating less – has the biggest impact on weight loss. Exercise helps, but it must be more than 60 minutes per day to be meaningful. In other words, physical activity is more important for improving health (a good thing!) than for accelerating weight loss.

Sources: UNC Nutrition Research InstituteAmerican Heart AssociationASU Human Performance Laboratory

To Supplement or Not to Supplement: That Is the Question

TIME reported on a new study this week that ultimately concluded that taking nutritional supplements is not the same as eating a healthy diet. Researchers report that you cannot be truly healthy without getting your nutrients from the source – from fruits, vegetables, and other plant-based foods.

My first thought: We call them “supplements” for a reason, right? They are intended to be “supplemental” to a mostly healthy diet. They are “supplements” not “replacements.”

A second thought: Not all supplements are created equal. I’m certainly not an expert on what makes a nutritional supplement effective or not, and I’m not sure how the scientists from this study qualified a “supplement,” but I do feel compelled to mention briefly the philosophy behind the nutritional supplements produced at Standard Process, my current employer.

An SP Aside

Standard Process produces nutritional supplements using ingredients from their organic farm in Palmyra, Wisconsin. Unlike other supplement companies, they boast a whole-food philosophy. This is based on the science of a whole food matrix, the idea that macronutrients (fat, carbohydrate, protein), micronutrients (vitamins, minerals), and phytonutrients (carotenoids, resveratrol, etc.) are the most bioavailable/biologically active/effective when they are consumed in the natural “matrix” in which they are found in nature. This separates Standard Process and other companies with a similar whole food philosophy apart from supplement companies that simply extract vitamin D or beta-carotene and insert them into a capsule to sell as a supplement.

That being said, I should clarify that my personal philosophy is food first, supplements second (if at all). We may not know for sure what types of supplements are most effective or if any are effective at all at improving nutrition, but you certainly can’t go wrong with getting your nutrition straight from the source (plant foods).

Okay, let’s talk about this new research.

TIME reporter Jamie Ducharme begins the story with two important facts:

I think it’s fair to extrapolate from those two statistics that many of those 90% of Americans that do not eat enough fruits and vegetables are among the 75% who are taking dietary supplements, likely because they know that they aren’t getting enough nutrients from their diet. Fair – it’s certainly easier to pop a pill than to get enough servings of leafy greens every day, but those 75% might be wasting their money on supplements that aren’t giving them the nutrition they really need.

The Study: Annals of Internal Medicine

The study’s main point is this: “nutrients consumed via supplements do not improve health and longevity as effectively as those consumed through foods.” Pretty simple. Supplements are not as good as food. Anyone surprised?

More specifically, researchers report that nutrients consumed through supplements are not as strongly associated with living a longer life as nutrients consumed through food. The data comes from the National Health and Nutrition Examination Survey (NHANES) 1999-2010, including 30,000 American adults as participants who were followed for about six years (at the end of this period, there were more than 3,600 deaths).

Researchers factored in monthly supplement use and dietary habits when establishing nutrient levels for each participant. This data initially led them to the result that dietary supplements are associated with a lower risk of early death, but that result did not hold true with researchers factored in certain other details about the participants: education levels, socioeconomic status, and demographics. After controlling for these variables, researchers found that it was mostly the higher-income and better educated people who were taking supplements, and this group is on average more likely to be healthy anyway. Put another way: for this group, it wasn’t supplement usage that was improving health, it was the impact of wealth and education on health (another story for another day).

The study showed that sufficient consumption of micronutrients like vitamin A, vitamin K, magnesium, zinc, and copper are associated with a lower risk of dying early, but only when obtained from food – not supplements.

Researchers even mentioned potential negative health associations with supplement usage. For example, high doses of calcium via supplement was associated with a 53% higher risk of dying from cancer compared to people who did not take supplements. Excess calcium from food did NOT have that association.

Regulatory Considerations

I think it’s important to note that the Food and Drug Administration (FDA) not does not regulate nutritional supplements as tightly or in the same way as “conventional” foods and drugs are regulated. Whether it’s safety or efficacy that one is worried about, the regulatory difference is a significant factor.

Supplements for Specific Populations

Lastly, I’ll highlight that the study scientists did mention that nutritional supplements may provide positive health benefits particularly for two groups:

  • The elderly: because the ability to absorb nutrients from food can decrease with age
  • People with dietary restrictions (allergies, vegan, vegetarian, etc.): because they are more likely to have nutrient deficiencies from lacking certain foods

Take-home Points

  1. While I acknowledge that it’s certainly easier said than done (I struggle in my own life), I agree with study co-author Fang Fang Zhang (Tufts University Friedman School of Nutrition Science and Policy) when she recommends that instead of relying on nutritional supplements, people should just eat a healthy diet rich with fruits, vegetables, and whole grains.
  2. There’s always more to the story. That’s why I included my SP aside earlier. The conclusion is never going to be “all supplements are bad” or “all supplements are good.” There are so many factors that affect what makes an effective nutritional supplement, and the only way to truly determine what’s effective and what’s not is to follow reputable research like this study from Zhang and others at Tufts University.

What’s Killing Us? What We’re NOT Eating

Health effects of dietary risks in 195 countries, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017
The Lancet

All the major news media outlets are reporting on this story today as if it’s some big surprise. But is it really surprising that a diet high in sodium, processed food, and sugary beverages and low in whole grains, fruits, and vegetables leads to millions of deaths worldwide?

The new study, funded by the Bill & Melinda Gates Foundation and published in The Lancet yesterday, investigated the burden of a diet devoid of healthy foods and its effect on non-communicable diseases.

Non-communicable diseases, also referred to as chronic diseases, are those that are the result of “genetic, psychological, environmental, and behavioral factors,” opposed to being caused by bacteria or other microbial agent. For example, you don’t “catch” heart disease from someone – you develop the disease as a result of factors like what you eat and what genes your parents passed on to you.

More on non-communicable diseases from the World Health Organization.

Researchers evaluated consumption of major foods and nutrients across all of the world’s 195 countries in adults 25 and older, analyzing how a diet lacking healthy food impacts mortality and morbidity.

Note: I didn’t realize that there were 195 countries in the world until I googled it to see how many countries were missing from the study. Here’s one of many resources that said 195 is the correct number.

They took a “comparative risk assessment approach” that accounted for:

  • Intake of each dietary factor
  • Effect size of dietary factor on disease endpoint
  • Level of intake associated with the lowest risk of mortality

Diet factors include:

  • Unhealthy red and processed meats
  • Sugar-sweetened beverages
  • Trans fatty acids
  • Salt
  • Fruits
  • Vegetables
  • Whole grains
  • Milk
  • Calcium
  • Nuts and seeds
  • Fiber
  • Legumes and beans
  • Omega-3 fatty acids and other polyunsaturated fatty acids

They found that the top three dietary risk factors associated with non-communicable disease are high sodium intake, low whole grains intake, and low fruit intake. These three dietary factors account for more than half of all deaths attributable to diet.

The report showed that the same risks associated with poor dietary choices affected people regardless of age, sex, and “sociodemographic development of place of residence.”

Finally, the study calls attention to the importance of acting in light of these and other similar findings. Experts call for dietary interventions based on evidence, a way to evaluate health and efficacy of dietary interventions on a regular basis. Past efforts have focused largely on salt, sugar, and fat. While high intake of those things definitely isn’t good for health, the current study highlights a second issue, one that now seems more important: yes, lowering intake of salt, but also increasing intake of healthy foods like whole grains, fruits, vegetables, and other plant-based options.

Algorithm for a Healthy Diet

What can artificial intelligence do for human health? Revolutionize the way we eat, potentially. An opinion article published in the New York Times on Saturday covers the idea of personalized nutrition, made possible by super advanced algorithms and artificial intelligence (A.I.).

The article “The A.I. Diet” is written by cardiologist Eric Topol, and he begins by describing his experience as one of more than a thousand participants in a two-week health study where a sensor and a smartphone app helped track everything he did: eating, sleeping, exercise, and more.

Topol’s data was analyzed by A.I. to ultimately produce a personalized diet algorithm. His results consisted of specific foods receiving a grade, like you would on a test. It seems to me that both his experience and the study design overall highlight the importance of understanding how different foods are good or bad for different people – i.e. blueberries affect me differently than they affect someone else with a different genetic code and lifetime of environmental exposures.

Interestingly, a version of Topol’s study exists as an actual test – commercially available – but analyzes gut microbiome only, not glucose levels or eating habits (here, but it is likely other companies sell something similar).

Topol points out that the main problem is that we often perpetuate the “idea that there is one optimal diet for all people.” More or less, any specific guidance that goes beyond Michael Pollan’s famous quote (and a personal favorite of mine), “Eat food, not too much, mostly plants” is assuming too much about the similarities between individuals, complex and important factors like microbiome status, genetics, and environmental history. Topol: “[This assumption] contradicts the remarkable heterogeneity of human metabolism, microbiome and environment.”

“We know surprisingly little about the science of nutrition.”

Why? Topol cites difficulty with high-quality randomized trials, which are vital for nutrition science (or any type of science for that matter).

“The more understanding we have of foods and nutrition, the more complex food and nutrient interactions become,” explains nutrition scientist Kristine Polley, PhD. “Therefore, controlled and well thought-out study designs are becoming essential to interpret and translate results. High-quality randomized clinical trials provide insight into how nutrients affect human physiology and allow for accurate and critical interpretation of the data collected and the opportunity to apply these outcomes to better overall human health and quality of life.”

Another issue specific to nutrition science studies is that experiments with food habits require strict diet adherence, and there is not always an effective or easy way to ensure study participants are actually following the study’s prescribed diet.

Thirdly, where does the money come from for these types of studies? Unfortunately, often from companies that benefit from the results of the studies, increasing the chances that the results will be swayed one way or the other or misconstrued. In Topol’s words:

“The field [of nutrition science] has been undermined by the food industry, which tries to exert influence over the research it funds.”

The future of individualized/personalized nutrition depends heavily on the success of dependable nutrition studies. This data is vital for building the sophisticated A.I. technology needed to analyze the mass amounts of data to determine each individual’s specific nutritional needs. So the question that remains unanswered is, can nutrition scientists get it together (and find the funding) to obtain the needed results? I think they can.