For over 40 years, conventional wisdom has been that saturated fat causes heart disease and therefore should be avoided or reduced.
The targets for reduction have gone progressively down over that time from < 10% to the current recommendations from the American Heart Association of 5-7%.
During this time, the rate of cardiovascular disease (CVD) has decreased to approximately 1/3 of their 1960's levels. While there are many factors (decline in smoking, better control of hypertension, use of statin drugs, and the timely use of blood thinners in acute myocardial infarctions) some cardiologists point to this decline as proof that the nutritional recommendations made in the late 1970's to reduce fat intake and specifically target saturated fat is a big part of this success.
More recently, prominent experts have begun to challenge this.
"Is saturated fat bad for you?", remains one of the most contentious and confusing questions in medicine today.
I would like to unpack this for you, give you some background, and lay out a practical non-dogmatic approach for you to follow personally.
Background - The Diet:Heart Hypothesis"
In the 1960's several observations were combined to form the diet:heart hypothesis which stated:
Lowering cholesterol by replacing saturated fat with poly unsaturated fat (PUFA) from vegetable oil would:
This hypothesis, which has been the dominant paradigm for cardiology over the past 40 years was based on:
The logic of the diet:heart hypothesis:
The problem with the Diet:Heart hypothesis is that there has been no solid evidence to support the logical leap (A--->C)
The original evidence to support the notion that decreasing saturated fat lowers coronary artery disease came from epidemiological studies in the 1960's that demonstrated a positive correlation between national levels of dietary fat consumption, and specifically saturated fat, and mortality from heart disease. The most famous (or infamous) study was performed by the legendary Ancel Keyes and was called the "7 Country Study".
This was an observational study based on fairly low-quality data: food diaries and public health records on cause of death. It also was not originally based on 7 countries - Keyes actually reviewed 22 countries - and when the whole dataset is reviewed the correlation, while present is far weaker. This has led to the suggestion that Keyes essentially cherry-picked the data to make the correlative conclusion stronger. He also refused to look at outlier cultures with very high saturated fat consumption and low rates of heart disease: Masai, Inuit etc.
By today's standards the 7 Country Study would be considered deeply flawed, and in fact recent observational studies have shown different results.
Most recently the PURE study, a large 18 country epidemiological cohort study that followed 135,335 people for an average of 7.4 years, demonstrated that high carbohydrate intake was associated with higher risk of total mortality whereas total fat and saturated fat intake were related to lower total mortality. Specifically saturated fat intake was not associated with increased risk of cardiovascular disease, heart attack, or cardiovascular disease mortality, and was actually associated with a decrease risk of stroke.
Of course, the challenge with these observational studies is that the best they can do is show correlation.
But correlation is not causation - my favorite example of this is the number of bathrooms one has correlates with net worth - the higher one's net worth the more bathrooms. Now if we confuse correlation with causation, we could erroneously conclude that having more bathrooms leads to higher net worth and could advocate that individuals should build themselves new bathrooms to increase their wealth!
The gold standard for proving causation is the randomized controlled study. This is where the diet:heart hypothesis really seems to fall apart.
No randomized controlled study has shown that replacement of saturated fat with vegetable oil significantly reduces coronary heart disease or mortality.
One randomized controlled study that attempted to test the causal role of saturated fat in heart disease was the Minnesota Coronary Experiment (MCE).
Conducted from 1968 - 1973, MCE was the largest (9570 people) and most rigorously executed trial of the diet:heart hypothesis, and the only one to ever include post-mortem assessment of coronary, aortic and cerebrovascular atherosclerosis grade and infarct status.
The MCE followed over 9000 institutionalized people living in state mental institutions and nursing homes and randomly assigned them to two groups: one that maintained the standard diet high in saturated fat and the other group in which half of the calories from saturated fat were replaced with vegetable oil and corn oil margarine - high in the Omega 6 PUFA linoleic acid. Unlike observational studies, the MCE had detailed records of every meal administered to these subjects over a 56 month period.
This study probably could never be repeated as today's ethics boards would not approve experimenting on institutionalized patients without consent, and it would be impossible to control diet to the extent that they were able to in this trial.
So what were the findings:
In keeping with the first part of the diet:heart hypothesis - replacing saturated fat with linoleic acid did lower cholesterol by an average of 14%, BUT this lowering of cholesterol DID NOT result in people living longer.
In fact, the lower the cholesterol the higher the rate of death (22% for every 0.75 mmol/L) and the vegetable oil group did not have fewer heart attacks or fewer atherosclerotic plaques.
So the MCE, the most rigorous trial ever done to test the diet:heart hypothesis essentially disproved the notion that decreasing saturated fat improves cardiovascular outcomes –it even suggested that increasing vegetable oil was associated with poor outcomes.
If this rigorous study was finished in 1973 and essentially disproved the diet:heart hypothesis, why did it not change the prevailing wisdom that saturated fat was bad?
It did not change minds because it was never published!
The investigators led by Ivan Frantz did not publish because the results were not what they expected and they felt that something must have been wrong with their data. When part of the study was published in 1989 it only reported that the substitution of saturated fats with vegetable oils did not reduce the risk of heart disease or death.
It was not until 2017, that the full data was analyzed and the true results were presented. This study by Christopher Ramsden, was assisted by Ivan Frantz’s son Robert (a prominent Mayo clinic physician himself) who had found old computer tapes and documents in his father’s basement. Ivan Frantz died in 2009. The account of this discovery was the subject of a brilliant Malcolm Gladwell podcast “The Basement Tapes”
It was Ramsdem et al. who showed that when the whole data set was thoroughly reviewed that the MCE study results are counter to the diet:heart hypothesis and show that the replacement of saturated fat with vegetable oil increases coronary events and death.
While this was the first full reporting from the MCE trial, a 2013 re-analysis of another 1960’s era landmark study – the Sydney Diet Heart Study (again by Ramsden) also showed that volunteers that replaced much of their saturated fat with polyunsaturated fats high in linoleic acid had a higher risk of death from heart disease.
In 2014, Chowdrury et al. reported a meta-analysis of 78 studies involving 650,000 people and concluded that there was no evidence that lowering saturated fat and increasing polyunsaturated fat intake decreases the risk of cardiovascular disease.
A landmark 2015 systematic review and meta-analysis of observational studies showed no association between saturated fat consumption and
These studies in many ways disprove the diet:heart hypothesis as overly simplistic. Focusing on evidence that saturated fat elevates LDL cholesterol misses the fact that increasing saturated fat in the diet also increases HDL cholesterol and lowers triglycerides.
In recent years, the ratio of TG/HDL has been shown to be the best predictor of heart disease, superior to LDL cholesterol. Ratios that included HDL: Total Cholesterol/HDL and LDL/HDL also are stronger predictors that LDL alone.
Other evidence points to evidence that LDL particle size is likely more important than total LDL measurements. Individuals with small, dense LDL particles (Phenotype B) are at greater risk than individuals with larger, more buoyant LDL particles (Phenotype A).
Interestingly a high TG/HDL ratio correlates with the atherogenic Phenotype B – small, dense LDL particle size as well as insulin resistance.
Returning to the logic of the diet:heart hypothesis:
On the whole, this brings us to the answer to our question – Is saturated fat bad for you?
The overall evidence from these studies says probably not – but the real answer lies in your own individual response to increases or decreases in saturated fats, polyunsaturated fats, and carbohydrates. Specifically, what we track at Wellness Garage are your HDL, tryiglycerides and LDL particle number – in addition to markers of inflammation and insulin resistance, and with this data we have a far better idea of what effect your diet is having and what risk you face from cardiovascular disease.
Our view is not conventional wisdom – but we believe that it does represent the emerging consensus view
At Wellness Garage our approach is personalized:
If you think that you benefit from a personalized approach to cardiovascular risk - please reach out to us and book a free consultation, we can help you come up with a plan to address your health needs.
For those of you following closely, I apologize that this blog post is a few days late, I have been working a long article on "Saturated Fat - Good, Bad or ...?" (Stay tuned, it's taking me a bit longer than I expected but I think it will be worth the wait.)
In the meantime, I wanted to share something with you that I think is really relevant and actionable.
UCSF pediatric endocrinologist Dr. Robert Lustig lays out a powerful indictment of the food industry in a talk entitled "Processed Food: An experiment that failed"
This is definitely worth the time to watch - Lustig is a great speaker and the information he shares is damning.
If you don't have time - here are some selected notes that are worth reflecting on:
What is processed food? (Food Engineering Definition)
What is processed food? 3 things too little - 8 things too much (Nutritional Definition)
3 things too little
Sugar is addictive and harmful to our health
Of the 600,000 food items in the American food supply - 74% have added sugar! Therefore sugar is the marker for processed food.
Lustig explodes the myth that all calories are equal - promoted by Coca Cola to justify that 180 calories of Coke is equal to 180 calories of vegetables.
You are not what you eat - you are what you do with what you eat.
The higher intake of sugar and industrial vegetable oils intake in the past 30 years - in response to the low fat and saturated fat recommendations (I will have more on this next week) are the two leading factors behind the high rates of obesity and metabolic syndrome.
The metabolism of sugar leads directly to fatty acid synthesis in the liver, and in excess - fatty liver disease, obesity, metabolic syndrome and diabetes.
For cardiovascular disease, the data is very clear - the more sugar, the higher the rates of disease:
Lustig and his colleagues estimate that 25% of diabetes worldwide is explained by added sugar consumption.
Lustig finishes with the societal math:
In other words - the US food industry costs the healthcare system $1.8 trillion per year - more than 3 times it's gross profit - this is truly crazy!
(while these figures are from the US, the numbers in Canada and elsewhere are headed in the same direction)
As I have written elsewhere on this blog, cardio-respiratory fitness (V02Max) and muscle strength are both independent and powerful predictors of longevity.
Ruiz and colleagues carried out the most comprehensive study examining the influence of muscle strength and cardiorespiratory fitness on healthy aging. They found that for those over 60, both all-cause and cancer mortality is twice as likely in individuals with low compared to high skeletal muscle strength, and irrespective of strength, low cardio-respiratory fitness is associated with twice the incidence of all cause mortality.
Aging is characterized by a decline in the capacity of the body’s major organs, in particular the loss of muscle (sarcopenia) and loss of bone (osteopenia) have severe consequences on the quality of life as we age. From a metabolic perspective, a healthy muscle mass with frequent exercise provides a sink for glucose, making it easier to maintain blood sugars and avoid insulin resistance. The decline of healthy, functional, skeletal muscle, correspondingly is one of the major factors leading to insulin resistance, with higher levels of insulin causing inappropriate fat deposition throughout the body further compromising organ function. Quite separate from the metabolic effects of diminished muscle mass, the loss of functional endurance, strength and range of motion effects locomotory function, compromises balance, increases risk of falls and fractures and leads to diminished health span.
Given the clear benefits of muscle strength on healthy aging one key question is what should you do to preserve muscle mass, strength and function across lifespan?
There is clear evidence that the trajectory of sarcopenia and muscle loss is highly dependant on activity - in other words exercise dramatically diminishes the loss of muscle associated with age.
Repeated resistance exercise results in increased muscle mass by stimulating protein synthesis within the muscle. With aging there is evidence that there is some anabolic resistance to the effect of exercise but that this can be overcome if a sufficient stimulus is maintained.
Protein is the essential macronutrient in the diet for the maintenance of muscle strength, mass and function. The current RDA for protein intake to meet whole-body metabolic demands has been stet at 0.8g/kg/day - but this guideline does not differentiate between young and old or between individuals looking to gain or maintain muscle mass. As with many things nutrition related, these one-size fits all metrics don’t make much sense. A better way to think about protein intake, is that they should be optimized to levels that promote maintenance of muscle mass throughout the lifespan.
An interesting recent review looked much more closely at this question of how much protein is optimal if you are trying to gain muscle. This meta analysis found that weight lifting regardless of protein supplementation led to strength gains, but for those who increased their protein strength was increased by about 10% and muscle mass by about 25%. When looking for the optimal amount of protein, the sweet spot seems to be around 1.6 mg/kg/day - or roughly twice the RDA. Above this level there was no additional advantage. Interestingly this review did not find any advantage to the type or timing of the protein intake. This may be because the underlying studies were very small, as there is basic science support for the notion that the muscle’s anabolic response to amino acids is maximal in the post workout period and that branded chain amino acids (BCAA’s), in particular leucine are the most potent stimulators of anabolism through the mTOR pathway.
Here's the bottom line:
While I won’t get in too much detail here, I would like to point out that when it comes to macronutrient levels there is no simple formula that fits everyone - in fact this is something that needs to be adjusted to each person’s unique genetics, environment and behaviours.
For proteins, we have just seen that the optimal level of protein needs to be adjusted to the level of anabolism - more muscle mass increase requires more protein, maintenance less, and under no circumstances do we want the dietary intake of protein to trigger catabolism or muscle breakdown. So we need to define protein intake by the person’s goals - maintenance or anabolism - and adjust accordingly. Dietary proteins that are not used for the body’s protein repair, maintenance and increase of muscle mass, are generally excreted and not used for energy provision.
In many ways, our protein rule is to find the minimum level of protein that meets our goals - maintenance or anabolism.
For carbs the task is reversed, we should titrate the maximal amount of carbs that we can tolerate while maintaining low and flat blood sugars without any sign of insulin resistance. For people that are already showing insulin resistance, this level will be very low - hence the low carb approach for metabolic disease. For others, (healthy cross-fitters for example), burning lots of calories in metabolically healthy muscles the amount will be higher.
And that brings us to fat, the calories that we do not get from carbs to meet our daily requirements must come from fat. Our energy requirements must be met by our intake of fats and carbs. So it you have insulin resistance and are carb intolerant, your fat intake must increase.
For today, I will leave it here, but add one last comment, the most important thing to remember about anything related to nutrition is that the source of any of your calories should be coming from nutrient dense whole foods that are not processed or refined.
Humans need to eat. Cells throughout the body are predominantly fueled by glucose delivered through the blood.
In evolutionary times food was not predictable, most often scarce, sometimes abundant. To maintain a consistent energy supply of blood glucose, evolution created a complex signaling system to control the process, delivering glucose when it is needed and efficiently storing it, when calories are abundant, ready to be mobilized in times of scarcity. Two hormones are central to this signaling process: insulin and glucagon. When blood sugar drops, pancreatic alpha cells release glucagon which then triggers the release of glucose from the liver. Correspondingly, when blood sugars rise, pancreatic beta cells release insulin which promotes glucose uptake in the liver and muscle, storing it as glycogen initially and then when glycogen stores are maximized, insulin prompts the conversion of carbohydrates and proteins to fat, our most efficient way to store calories for the future. Both insulin and glucagon are small proteins recognized by specific receptors on individual cells.
This process, developed over 600M years of evolution, now is under challenge in humans. The conditions for which we are optimized: calorie scarcity with intermittent abundance, no longer exist. Instead we live in a world of continuous excess calories, with processed foods that rapidly spike blood sugars and trigger massive insulin release, and correspondingly massive insulin directed storage of excess calories as fat in adipose tissue.
For many this process has become a one-way street, the flexibility to shift metabolically from glucose to fat as fuel that was once the key to our survival has, for many people, been lost. They are dependent on maintaining blood sugars through the constant consumption of carbohydrates. - if you find yourself craving sweats, getting tired after eating and feeling generally fatigued - this could be happening to you.
As a result of excess calories, sedentary lifestyles and this loss of metabolic flexibility, global levels of obesity are soaring: 2 Billion people are overweight - 650M are obese. In Canada close to 50% of the population is overweight!. With obesity has come a corresponding epidemic of obesity related diseases:
The cellular mechanisms by which insulin resistance manifests are complex and beyond the scope of this blog, but at a high level, dysfunctions in three areas appear to alone, or in combination affect the ability of insulin to efficiently activate the insulin receptor and trigger the cascade of reactions that allows insulin to do it's job:
The process by which insulin resistance progresses to pre-diabetes and diabetes is understandable and predictable - it is also very preventable.
As insulin resistance sets in, muscle, fat, and liver cells do not respond properly to insulin and thus cannot easily absorb glucose from the bloodstream. As a result, the body needs higher levels of insulin to help glucose enter cells.
The beta cells in the pancreas try to keep up with this increased demand for insulin by producing more. As long as the beta cells are able to produce enough insulin to overcome the insulin resistance, blood glucose levels stay in the normal range.
Over time, the processes that led to insulin resistance in the first place cause pancreatic beta cells to become less efficient and eventually triggers beta cell death. As this begins to happen, blood sugars fall out of the normal range and people begin to be diagnosed with pre-diabetes or diabetes on the basis of abnormal blood sugars.
The time that it takes to progress from insulin resistance to pre-diabetes is generally in the order of 10-15 years - during this whole time a person will have normal blood sugars and may feel reassured that they do not have diabetes - YET - they are manifesting the underlying process of insulin resistance that will lead to diabetes and it's complications.
So the big question that you should be asking is - how do I know whether I have insulin resistance?
Direct testing of insulin response is not broadly available, so we are most often left looking for other signs of insulin resistance.
For the most part, we can work with this:
My blood sugars are normal, but I think I have insulin resistance, what do I do
The good news is the process that leads to diabetes is reversible through lifestyle changes:
One of the major reasons we started Wellness Garage was to help people intervene early in preventable disease processes like insulin resistance rather than wait until blood sugars become abnormal (after 10-15 years!) and prescribe medications.
If you think that you could be affected by insulin resistance - please reach out to us and book a free consultation, we can help you come up with a plan to address your health needs.
Dual X-ray Absorptiometry - DXA is the Gold Standard for body composition. The technology uses two x-ray beams of differing energy levels to scan a person’s whole body. The difference in the absorption of the two beams by the three major body compartments: bone mass, lean muscle and fat provides the data that allows for a computer to determine a person’s:
Modern lifestyle, with too much food (of questionable quality) and too little exercise leads to some inevitable consequences. Body fat increases, lean muscle mass decreases and bone density decreases. From a physiological perspective, there is nothing inherently wrong here - this is actually how the body was designed:
Most often these changes are recognized when a person becomes overweight and we use their Body Mass Index (BMI) - an index that attempts to define the amount of tissue per standardized unit of height - it does this simply by dividing the height by the weight squared and is measured in kg/m2. But BMI does not differentiate between bone, muscle or fat. So if you are very strong with large muscles and large bones on an average or even small frame - your BMI may tell you that you are overweight. Commonly accepted BMI ranges are underweight: under 18.5 kg/m2, normal weight: 18.5 to 25, overweight: 25 to 30, obese: over 30.
More challenging then the strong muscular person who is labelled overweight (most physicians generally recognize this), is the opposite situation: a person with decreased lean muscle, decreased bone density and increased fat where their BMI places them as normal even though from a body fat percentage they are obese. This is far harder to detect in clinical practice, and is probably more common than most realize.
The second reason to want a DXA - even if, in fact, especially if, you are obese, is to understand the nature of your obesity. Fat accumulation around the visceral organs in the abdomen is highly associated a destructive self reinforcing cycle of inflammation, insulin resistance, high blood sugars, hypertension, hypercholesterolemia and in turn more adipose fat accumulation. This viscous cycle, known as metabolic syndrome, is highly associated with diabetes, heart disease and stroke.
Shockingly, according to a 2011 study almost 1 in 5 (19.1%) of Canadians are estimated to have metabolic syndrome, and most are undiagnosed, (and I suspect things have gotten worse in the last 7years!)
The most common component of metabolic syndrome in Canadians: abdominal obesity.
A low tech approach to estimating abdominal obesity is to measure the waist to hip ratio - anything above 0.9 for men and 0.85 for women is considered by the WHO to signify abdominal obesity. Less accurate than a DXA and without the lean muscle and bone density information, but a critical metric nonetheless.
Reason #3 - DXA provides hard-to-get-otherwise information
Maintaining lean muscle mass, along with strength and bone density are strongly positive indicators for longevity - or said another way: loss of muscle mass and bone density are associated with premature death.
Here the challenge for the clinician is greater than with abdominal obesity. Often there is simply no way to know a patients lean muscle mass and bone density without DXA measurement.
Reason #4 - this is the best part
So we now know that DXA gives us some really good information, but the best part is that all of the important markers for vital longevity it tracks
Reason #5 - DXA scans are very safe and can be repeated multiple times in a year.
But don’t they use x-ray radiation?
Reason #6 - DXA scans are relatively inexpensive
DXA for total body composition is not an insured service, so cost will be an issue for some.
However, given the nature of the test and the data they produce for many DXA's are a cost effective investment in their health. ($120 for the first test; $100 for follow-up scans.)
In summary - 6 Reasons Why DXA Scans are so useful
At Wellness Garage, we are proud to announce that Bodycomp Imaging is locating a DXA scan within our facility that will be available for our clients as part of our assessments.
We are very excited to see this technology come to the South Surrey/White Rock area. Clients are free to book with Wellness Garage or Bodycomp at their convenience.
* Wellness Garage and Bodycomp are independent businesses - and Wellness Garage derives no profit from DXA scans done at our facility.
“in order to keep well, one should simply avoid too much food, too little toil”
"The doctor of the future will give no medicine, but will interest his patients in the care of the human body, in diet, and in the cause and prevention of disease."
- Thomas Edison
The evolutionary process, from which modern humans arose, selected for traits optimized for an environment very different from what we live in today. Our hunter-gather forebearers, walked and ran long distances, often carrying significant weight. Hunger was a frequent companion, and they ate when, and as much as they could. Night-time was dark, a time for rest and sleep, daytime was active. By our standards, they were filthy - colonized by a diverse collection of bacteria, fungi and viruses. And though their microbiota were large and diverse their social groups were small - no greater than 150 people.
Not surprisingly, evolution selected human genes that optimized our abilities to be calorie efficient and benefit from activity. We are designed to store excess calories in fat, to draw upon when calories are scarce, as they so often were. Our muscles and bones get stronger with usage. Our bodies operate on a diurnal rhythm with up to 30% of our genes turned on or off by the light-dark cycle, building in regular periods for cellular repair and regeneration. Many of our biological systems depend on interaction with a diverse variety of micro-organisms and their genetic products. Socially, our capabilities max out at around 150 relationships.
So we find ourselves in an evolutionary mismatch between the world our genes were selected for and the sedentary, fast-food, 24 hour, constant stimulus, Facebook world.
It is any wonder that the diseases we increasingly face at epidemic levels are rooted in this mismatch?
Simply put, we are not designed to live the modern lifestyle.
Lifestyle medicine leverages this insight by utilizing lifestyle interventions such as nutrition, physical activity, stress reduction, sleep, smoking cessation and the avoidance of alcohol abuse to prevent, manage and reverse disease.
This approach can be implemented at any point in a disease process, but it is important to realize that since most chronic diseases take 15 to 20 years to develop, environmental evolutionary mismatches slowly disrupt biological systems eventually cascading towards disease. These disruptions can be detected prior to the diagnosis of disease, and reversed through lifestyle behavioural interventions. Progress can be measured through improvements in key biomarkers. This strategy can be used alongside conventional medical approaches to help manage and actually even reverse disease. The most powerful examples of disease reversal come from Ornish’s (http://www.healthways.com/blog/the-future-of-health-care) work with heart disease and the recent application of therapeutic nutritional strategies for diabetes.
It is no wonder that Lifestyle Medicine has been called "the Future of Healthcare”.
At Wellness Garage, we use a lifestyle medicine approach to precisely assess our client’s current risk - we then help them develop lifestyle strategies to optimize their health and prevent disease. Where disease is present, we look to manage and reverse the underlying processes, often eliminating the need for medications. Our approach is evidence based and personalized to each client’s goals.
To learn more - book a free consultation or request more information
As many of you realize, I love the science of systems biology and really enjoy researching and explaining how things work in our amazing bodies.
But as much as I enjoy sharing my wonder, I would never want people to think that health is something you need an MD or PhD to understand and optimize.
Today’s post contains some really simple, actionable things that you can do every day - starting today.
1. Eat minimally processed foods
Food is medicine - Food is poison.
The simplest, and best place to start is by eating minimally processed foods - or as Michael Pollan would say - Eat Real Food.
The evidence for this is overwhelming - processed foods (sugar, refined carbs, industrial vegetable oils, packaged goods with ingredients you cannot pronounce) are not good for you.
…and you will feel better.
While this sounds simpler than it actually is - it all starts with a decision to eat real foods, and to systematically avoid processed options, one choice at a time.
In our coaching programs, we help people make these choices - starting with easy substitutions and building over time.
7-8 hours of sleep - it does not get any simpler. Most people do not need more and very few of us can really get by on less.
Many studies have shown clear links between inadequate sleep and poor health: increased inflammation, hypertension obesity, diabetes and heart disease.
Adequate sleep also reduces improves sex, mood and thinking while reducing chronic pain, risk of injury or infection.
…and it feels better to get a good night’s sleep. It all starts with a simple decision to prioritize sleep. At Wellness Garage, our coaches can help you create a sleep ritual that will work.
3. Move more
Exercise is important, but it can take some work to develop an exercise routine that works for you. A simple first step - is to make a decision to move more. Get up often, walk more, take the stairs, park away from where you need to go - get off one subway station sooner than you need to. Think about moving - make the decision to be more active. Walk the dog - take a phone meeting while out walking - carry your groceries - do yard work - think of house work as exercise - anything that makes you use your body is good.
…and you will feel better - this simple decision will lead you to want to do more, making it easier for you to build up your exercise practice. Our coaches can help you find the exercise routine that works for you.
4. Get Outside
The Japanese have a term Shinrin Yoku - which literally means “forest bathing”.
The idea is to take a leisurely walk in nature, to take in the smell, the sounds, the feeling of being outside.
This simple act of being mindful in nature has been shown to improve health by boosting immunity, lowering blood pressure, decreasing stress hormones and improving mood.
…and it feels good. So go for a walk in your nearest park or woods, and bath in the atmosphere.
4. Spend more time with those you love
For this, I am not going to cite any research but ask two questions:
Prioritizing relationships is good for your health and it feels good.
Make the decision to do these five simple things, you will be healthier and you will feel better.
Wellness Garage is a precision lifestyle medical practice, combining medical expertise with a team-based approach including one-to-one coaching, personal training, nutritional counselling, education and digital tracking.
We provide comprehensive medical assessments of your health, using the latest, proven science, to help and support you:
To learn more - book a free consultation or request more information
Today I am going to provide a list of 7 biomarkers for you health - numbers you should know. These are all biomarkers that can be improved through lifestyle interventions - they are numbers that can be normalized and optimized - and in doing so you will reduce your risk for heart disease, diabetes, cancer, Alzeimher's dementia, kidney failure, arthritis and many other conditions. Optimizing these biomarkers will even decrease your risk of premature death. I think this should be a pretty good investment of 15 minutes of reading! (If you want to skip the reading - there is a quick summary at the end of this post).
2. Gamma Glutamyl Transferase (GGT) - optimal < 30 U/L
GGT measures a liver enzyme and is commonly described as liver function test most closely associated with the adverse effect of alcohol. GGT is however much more important as it is an indirect measure of the body’s glutathione supply. Glutathione protect cells against the oxidative stress resulting from metabolism. Without this protection the free radicals generated by mitochondria through normal metabolism with oxygen would accumulate, overwhelm and damage the mitochondria and the cell. In normal ageing it has been shown that it is this accumulation of oxidative stress that leads to many of the age-related diseases.
In many ways, glutathione is consider the master antioxidant: working with as part of the enzyme glutathione peroxidase to protect membranes from oxidation, enabling Vitamin E and C in their anti-oxidant capacities as well as working directly.
Glutathione is also a key component of the Phase II metabolism (detoxification) of drugs, hormones and xenobiotics where it works as a component of an enzyme Glutathione s-transferase (GST) that conjugates heavy metals, toxins and other compounds so that they become water soluble and can be excreted in the bile or urine.
Exposure to high levels of toxins that overwhelm glutathione in its Phase II metabolic role will lead to oxidative stress.
3. hsCRP - high sensitivity CRP - optimal < 1.0
Again another topic I have recently blogged about: chronic inflammation.
Chronic inflammation is at the root of 7 of the top 10 causes of death accounting for 80% of all deaths in our society. The most insidious aspect of this type of inflammation is its silent nature that allows for damage to occur without diagnosis.
HsCRP is the gold standard for assessing chronic inflammation - optimizing this number through behavioural change - diet, exercise, stress reduction - decreases the risk for many diseases.
4. Blood Pressure - optimal <115/75 (systolic/diastolic pressures measured in mmHB)
This is the simplest - something that you can do at home, at the local pharmacy and with your doctor. Normal blood pressure is 120/80. Recently there were major headlines in the US, noting a change in the definition of high blood pressure (hypertension), lowering the definition threshold to 130/80 from 140/90. While this change dramatically increases the number of people who will be diagnosed with hypertension - not all will automatically be recommended medications. Those recommendations will depend on a person’s overall risk for cardiovascular disease - anyone with a 10% or greater risk should aim to bring the BP below 130/80.
High blood pressure or hypertension is quantitatively the most important modifiable risk factor for cardiovascular disease (the largest contributor to premature death in our society).
It is also a significant risk factor for both kidney and heart failure.
For every 20 mmHg increase in diastolic blood pressure above 75, the risk of death from heart disease or stroke doubles.
Elevations in blood pressure are caused by dysfunctions within core biological systems
5. Fasting Blood Glucose and or HbA1c: optimal FBS <5.2mmol/L (normal <5.6 mmol/L); optimal HbA1c <5.0%
Maintaining normal blood sugars is one of the most important and tightly regulated functions in your body.
Diabetes mellitus (DM) is the condition when your body cannot maintain normal blood glucose levels. Type I DM is an autoimmune disease where the pancreas stops producing insulin. Type II DM, is characterized by insulin resistance, where the body no longer responds normally to insulin. In order to maintain blood sugars, the pancreas increases production of insulin - leading to elevated insulin levels which in turn trigger inflammatory changes, which in a vicious cycle further worsens insulin resistance. Insulin resistance precedes Type II Diabetes and can remain undetected for years, as glucose levels are maintain as normal until the pancreas begins to fail, which is relatively late in the process.
Diabetes is diagnosed when FBS >7.0 or HbA1c >6.5%
Type II DM is currently at epidemic levels globally having tripled since 2000. Almost 500M people or 1 in 11 have diabetes at an estimated cost of $850M.
The direct complications from diabetes come from damage to blood vessels at two levels:
6. TG/HDL - Triglyceride/HDL ratio - optimal <1.0
Of all the information that can be derived from a lipid panel the TG/HDL ratio provides the best information about risk.
TG/HDL is an excellent marker for insulin resistance and metabolic syndrome
When elevated above 3.5 - this is the simplest test to identify atherogenic dyslipidemia, which is marked by the joint occurrence of elevated TG, low HDL and atherogenic, small, dense, LDL particles. This is highly predictive of cardiovascular disease.
As we have seen above insulin resistance is the precursor to Type II DM and is often silent and undiagnosed, and is also one of the major causes of chronic inflammation.
7. Android:Gynecoid Fat Ratio - optimal <1.0
The major cause of the global diabetes epidemic is the associated obesity epidemic. Over
2B people are overweight with about 600M reaching the definition of obese (BMI >30).
For obese people cardiovascular disease is the leading cause of death and disability, followed by diabetes. Kidney failure and cancer are the other major causes of death.
Obesity, through adipocyte dysfunction leads to a chronic inflammatory state that
predisposes an individual for many diseases. Abdominal or visceral fat contributes
disproportionately to this inflammatory response as compared to peripheral fat.
The best way to measure visceral fat is with a DXA body scan, which provides you with
android:gynecoid fat ratio. The ratio correlates with insulin resistance, showing the clear
link between visceral fat and the pathogenesis of diabetes.
The added benefit of getting a DXA scan is getting understanding your lean muscle mass and bone density. As you age maintaining lean body mass and bone density are both essential for vital longevity avoiding age-related sarcopenia and osteoporosis.
A good alternative (without the extra bone and lean body information) is a waist:hip ratio. The optimal ratio for men in <0.85 and women <0.75.
Abdominal obesity is also a marker for metabolic syndrome - a cluster of conditions that carry risk individually but are collectively carry massive risk:
As you can see, all of the risks for metabolic syndrome have been covered by our 7 numbers.
According to a recent study - almost 1 in 5 Canadians, including 40% of people over 65 have metabolic syndrome . Unfortunately, many are unaware of it and have placed themselves at massively increased risk for diabetes, heart disease and premature death.
In Summary - 7 Numbers You Should Know
Inflammation is the normal process by which the body responds to injury. When cells are damaged by trauma or infection, they send signals that mobilize the bodies immune system to understand and address the situation. The acute inflammatory response is recognizable by five cardinal signs: calor; rubor, dolor, tumor and functio laesa; if you have just twisted your ankle: it’s warm, red, painful, swollen, and you cannot use it. This response makes sense as it alerts you to your injury, and forces you to rest while facilitating the repair, turnover and adaptation of the injured tissues, or in the case of infection inflammation also prevents the spread of pathogens to nearby tissue.
Without inflammation, we would not survive.
Our challenge is that inflammation is meant to be an acute, self-limited process that facilitates healing.
Chronic inflammation, unlike acute inflammation is a prolonged, maladaptive, low grade, persistent and dysregulated process that is the major contributor to chronic disease and ageing in our society. This silent but destructive nature makes inflammation a special challenge; by the time it is recognized, much of the damage has been done.
Inflammation is implicated in 7 of the top 10 causes of death in Western societies accounting for over 80% of deaths.
It is chronic inflammation that represents perhaps the biggest threat to our health and through the epidemic of chronic disease affects the sustainability of our health care systems.
So where does chronic inflammation come from?
The large variety of stimuli that fuel inflammation converge on a few basic mechanisms and pathways within cells - specifically the activation of the transcription factors NF-κB and Nlrp3 inflammasome which activate gene transcription and the production of inflammatory molecules called cytokines that interact with other cells to elicit a cascading response.
This response leads to increased plasma levels of pro-inflammatory cytokines (Interleukin-6, IL-6, Interleukin-1, IL-1 and Tumour Necrosis Factor-α, TNF-α) as well as increases in the main inflammatory biomarkers such as C-Reactive protein (CRP) and serum amyloid A.
This generalized pro-inflammatory state, interacts with genetic and environmental factors to potentially trigger the onset of inflammation-related diseases:
Given the multitude of triggers and profound potential consequences that chronic inflammation has, the logical question (if you have read this far) is:
Am I inflamed?
The standard test for this in the clinic is the high sensitivity C-reactive protein (hsCRP) - anything greater than 1.0 nmol/L suggests a low-grade inflammatory process, with levels greater than 3.0 nmol/L associated with elevated risk for heart disease (atherosclerosis). Levels greater than 10 nmol/L suggest an acute inflammatory response (infection).
What is an optimal strategy to avoid inflammation?
1. Maintain optimal gut microbiota health and prevent leakage of gut microbes into the body
If you are having symptoms or have concerns about intestinal permeability - there are tests that we can do to determine whether leakage of microbes from your gut is contributing to your inflammation.
Finally, if you are really interested you can check your microbiome and assess it's overall health - two caveats here: 1) there is huge variability between tests - these tests are really just snap-shots; and 2) there really is very limited data from these tests to direct you to a more specific response then I have outlined.
2. Minimize cellular damage from oxidative stress
4. Minimize the deleterious effects of high blood sugars and/or high insulin
Our society is in the midst of a diabetes epidemic - it is estimated that between 50-70% of the population has been diagnosed with diabetes, elevated blood sugars (pre-diabetes) or elevated insulin levels (insulin resistance - the precursor to diabetes). While there are clear genetic risk factors, the overwhelming evidence points to lifestyle: poor diet - excessive nutrients of poor quality - high carbohydrate, high fat, combined with physical inactivity leads to elevated insulin levels which initially maintain blood sugar levels at the expense of increasing the storage of calories in fat. This increased fat storage leads to obesity with overloaded fat cells becoming dysfunctional and senescent and secrete pro-inflammatory cytokines which in turn cause insulin resistance - creating a vicious cycle. The inflammation eventually affects the pancreatic beta cells, decreasing their ability to secrete enough insulin to maintain blood sugars and a person is diagnosed as diabetic.
The frightening part of this scenario is that it often takes 10-20 years to go from insulin resistance to diabetes - during that time levels of chronic inflammation increase as do the associated risks.
For diabetes and insulin treatment and prevention the place to start is with diet as it is the most likely culprit. A whole food, low carbohydrate, healthy fat approach is the way to go.
For diabetics on medication - ketogenic diets have an excellent track record as a therapeutic intervention to decrease or eliminate medications.
As you can see from these strategies to avoid inflammation, the answer lies in your behaviours - especially eating, exercising, sleep and stress. Your optimal strategy will come from assessing and understanding your current situation and addressing your behaviours in a systematic fashion.
If you are overweight (or simply over 40) you should, at a minimum, know your hsCRP, fasting blood sugar, HbA1c (3 month average of blood sugars), HDL cholesterol, LDL cholesterol, triglycerides and GGT (liver enzyme that also is a key marker of oxidative stress), as well as your waist to hip ratio. These are tests that every family doctor can (or probably has already) done for you - the important thing is for you to know. If any of these tests are abnormal (or not optimal), you should develop your own strategy to getting well. If these tests are normal, you should still review your core behaviours and assess what can still be improved.
At Wellness Garage, we deliver comprehensive lifestyle medicine assessments reviewing all of this data, along with other optional tests that are not routinely offered in the publicly funded system: molecular data (genomics, metabolomics, proteomics, microbiome, and other advanced diagnostic tests), DXA scans (to assess body composition). We use all of this data to help you build the optimal strategy for your own personal wellness. We then can match you to a personal coach to help you implement the behavioural changes necessary.
New Year’s Day is always a time for reflection, revaluation and resolutions.
Often we take a look at our lives, see what is lacking and resolve to “fix” it…all at once.
A flurry of activity, new gym memberships, calorie deficient diets and within 2-3 weeks we are back to where we started, Frustrated, we feel foolish to think that we could make the changes that we want in our lives.
Today, as you reflect, I would urge you to do something simpler.
Definitely take the time to reflect and reevaluate; understand where you are and where you want to be.
Take the time to look at your core behaviours:
Instead of trying to “fix” everything, all at once, look for your good habits and try to build upon them, extend and expand them. Start with habits that you already have, tune and tweak them to be a bit healthier, and a bit more consistent. Give yourself time to incorporate these changes one or two at a time. Finally, make the time to reflect everyday, for a few moments at least, like it is New Year’s Day and realize that every day is a good day to be be a little bit healthier.
At Wellness Garage, we believe in the power of habits, and that everyday is a good day to be healthy.
We have launched our 2018 Healthiest Year Ever program, combining comprehensive lifestyle medicine assessments with personal coaching to help you find your healthy path.
Check out the program here: https://www.wellnessgarage.ca/2018.html
If you want to learn more, please book a free consultation with us.
Happy New Year!!