Everything You Ever Wanted to Know About Losing Weight, Exercise, Stress, and Cardiovascular Risk from an Expert, Dr. Sharon Alger-Mayer. The Best Diet, How Much Exercise, the Hormone Stress Connection, the Best Phytonutrients, and the Healthiest Carbs

"Why is it so hard to to maintain a healthy weight and good eating habits?  It's multi-factorial.  Genetics loads the gun - but the environment pulls the trigger.

We are all different  genetically in our hunger and satiety cues--the rate at which we burn off calories, our dietary patterns, and the stress-causing changes in our brains."

-Dr. Sharon Alger-Mayer, Associate Professor of Medicine, Division of Clinical Nutrition, Albany Medical College, Albany NY-

"A habit cannot be tossed out the window; It must be coaxed down the stairs a step at a time."

-Mark Twain-

If you are receiving this post via email click here to get to the web version with all the links.

Would you lose weight and start to exercise if it could save you money?

Starting this year almost everyone at my place of work is getting with the Program.  The diet & exercise program.  If lowering cardiovascular risk, and feeling great isn't enough motivation--maybe money will work!  If we want to pay 2009 rates for our health insurance in 2010 & 2011 we need to show that we are either healthy, or we are taking serious steps to get healthy. 

If you have hypertension, elevated cholesterol, diabetes, asthma, are a smoker, or you are overweight (BMI above 27) you need to join a free program (including Curves or Weight Watchers) and reach the set healthy goals by November 2010 to get your rebate.

Everyone, even those of us who are already in good shape--must still participate by joining a small "team" & tracking one or more healthy behaviors:

• Weight loss
• Pedometer steps (and we've all received a free pedometer)
• Daily exercise minutes
• Cups of fruits & vegetables consumed

Yes, it feels "big-brother-ish", but you aren't forced to participate--and frankly, I don't know anyone who isn't.   I've just logged in my exercise minutes, and how many fruits & vegetables I've eaten--and I have to admit, it's a great way to keep me honest--and motivated!

So, now let's bring on our diet and exercise expert--Dr. Sharon Alger-Mayer.

What's Eating You?  Food, Mood, and Cardiovascular Risk

For the past weekend I've been "up to my ears" listening to a fascinating lecture by Dr. Sharon Alger-Mayer--all about how diet, exercise, stress, sleep, belly fat, and brain chemicals affect our cardiovascular risk.

The lecture title says it all:  "What's Eating You?  Food, Mood, and Cardiovascular Risk", Audio-Digest Foundation--Family Practice  58(8): Feb. 28, 2010.  Click here

I'm going to do my best to highlight some of the "new to me" research Dr. Alger-Mayer presents.  Stick with me--there's a lot to cover.

Here's a chance to benefit from the knowledge, experience, and wisdom of a top-notch specialist without making an appointment.  

If I had to sum it all up in 6 key points it would be:

• Eat a diet that is 750 calories less than what you need to maintain your present weight.  Get a diet buddy or join a support group for the best chance of success
  
• The type of carbohydrates you eat makes a big difference and they actually affect your insuling-signaling genes.  Eat Low-Glycemic Carbs!  That means foods like beans, legumes, oats, quinoa, dark rye bread, vegetables, & fruits.
  
• Exercise often--short bouts are best, enough to burn 2800 calories a week, including 11,000 steps a day (5.5 miles), & 2 days of more intense exercise a week
  
• Consider adding phytochemicals like (but not limited to) cocoa, green tea, resveratrol (grapes or wine), acai berries, or hops (rho-iso-alpha-acids)
• Get enough sleep--at least 7.5 hours
• Find a way to manage stress to reduce fat-causing hormones (like cortisol) that pack on belly fat and increase inflammation.  Simplest stress reducers:  Exercise and deep breathing--one deep abdominal breath, hold for count of 4, and repeat.

 Who Is At Risk?  Who Needs to Get With the Program?  Where Do You Begin?

 Lifestyle accounts for more than 50% of the deaths among middle-age women.

72% of cardiovascular mortality can be attributed to lifestyle factors. 

Metabolic Syndrome is what you want to prevent--or get rid of--if you have it.  If you've got a little too much belly fat, elevated blood pressure, high triglycerides, elevated blood sugar, low HDLs, and/or high triglycerides you're at risk for heart attack, stroke, and type-2 diabetes.  We're talking Metabolic Syndrome--and with the right diet, exercise, stress management, and the addition of some potent phytochemicals you just might turn that ship around.

Dr. Alger-Mayer's Prototype Patient:

• 52 year old woman
• High stress job, long hours, finds it hard to find the time to exercise
• Travels for work, eat too many restaurant meals, breakfasts on bagels or pastry, drinks 2-3 glasses of wine at night to wind down
• Poor quality sleep, wakes up frequently
• Feeling depressed, trouble concentrating, anxious, worried about her memory, worried about her health
• Insulin-resistance, high blood pressure, high cholesterol, family history of early heart attack, a history of weight issues, loses weight and puts it right back on.
• 5'6", 228 lbs, BMI of 37, waist circumference of 42" (>35" increases risk), elevated fasting glucose, HDLS & triglycerides are OK, LDL is elevated, C-Reative Protein (inflammation marker) is elevated at 3.4  Click here for BMI tables  Click here for CRP tables & "The Inflammation Connection"
  
• Meets criteria for Metabolic Syndrome even though none of her values are super high
• She is ready to get serious about losing weight and making a change     

Before getting started, here's what Dr. Alger-Mayer asks all her patients to do, because "knowledge is power".

• Keep a 3 day food record of what they are eating day-to-day
• Record how they are feeling--emotions & moods.  What's driving their food choices
• Wear a step counter for 3 days--not to change anything, but to see how active they are during the day
• Keep a 7 day record of their sleep cycle
• What are they doing for fun?  What do they have to look forward to?  What helps to diffuse their stress?

Getting Started When You're Feeling Overwhelmed - Where Do You Begin?

Dr. Alger-Mayer's typical patient is an intelligent bright woman who has struggled with this weight issue for many years. 

It's not just about knowing the issues.  She feels totally overwhelmed & challenged by life & finding the time & energy to make big changes is extremely difficult.

Alger-Mayer says you need to break down the process into a manageable set of goals.  Here's what Ms. Typical Patient wants to know from Dr. Alger-Mayer:

• Is there one diet that would be best for her particular medical risk factors?
• What about exercise? She knows she has to exercise, but how much does she need to do?
• Are there any nutritional supplements that would help?

Let's Talk Diet - What's the Best One?

• When it comes to weight loss--it doesn't matter.  According to a 2009 New England Journal of Medicine study that compared four different weight-loss diets (low vs. higher fat; low carb vs. higher carb; low protein vs. higher protein)--it just didn't make any difference.  All the diets achieved weight loss, and lowered cardiovascular risk factors, decreased waist circumference, and triglycerides.  The fasting insulin level dropped in all the diets except the 65% carb diet.  All 4 diets were basically healthy--they emphasized adequate fiber and low-glycemic carbs, were low in cholesterol, and participants were asked to do 90 minutes of exercise a week.  Most weight loss occurred in the first 6 months of this 2 year study that followed over 800 overweight adults.  Final conclusion: "Reduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize."
• What did make a difference?  The patients who attended at least 66% of the group support sessions lost the most weight--an average of 20 pounds over 2 years.
• To lose weight, you need to eat 750 less calories than you would need to maintain your present weight.
• Dr. Alger-Mayer emphatically points out that this study DOES NOT MEAN, that diet doesn't matter--and that you can eat whatever you want to, as long as you cut calories.  High fat and simple sugars are not good for you, and will not reduce your cardiovascular risk factors.
• My opinion: Go for plant-based, minimal to no added fats, low-glycemic carbs like beans, oats, legumes, fruits & vegetables, whole-grains, and minimal sugar.  No worries!

A Calorie is Not Just a Calorie.  Carbs Affect Our Genes.  What?

 Some recent landmark studies have confirmed that the kind of carbohydrates we consume actually affect the genes in our abdominal fat--which has a tremendous impact on developing or curbing Metabolic Syndrome.

• The Carbohydrate/Gene Study.  Here's how the the low vs high glycemic carb study played out in 2 groups of people with Metabolic Syndrome.  One group was fed carbs that were high fiber low-glycemic (think oats, beans, quinoa).  The others group was fed carbs that were high fiber high-glycemic (think potatoes, whole wheat bread).  Both carbs had the same amount of protein and fat.  The low-glycemic carb meal produced a low insulin response, and the insulin-signaling genes in the abdominal fat were actually down-regulated.  But after the high-glycemic carb meal,  insulin shot up, and 62 different genes that are linked to the stress response, insulin-signaling and cytokine-mediated immunity were turned on.  Pretty amazing!  This study prompted endocrinologist Dr. David Ludwig to write an editorial called, "Putting your genes on a diet: the molecular effects of carbohydrate."
• Take away point:  The kind of carbs we eat have a significant effect on the gene regulation that affects how our bodies handle insulin--and don't forget that abdominal fat is a marker for an insulin response that is out of whack.  This process has nothing to do with how many calories we consume, or how much we weigh--but it has everything to do with what kind of carbs we are consuming.
• The effect of whole grains vs refined grains on the risk of cardiovascular disease in Metabolic Syndrome.   In this study the two groups being compared both reduced their calories by 500/a day for 12 weeks--but one group ate whole grains while the other consumed refined grains.   After 12 weeks both groups had the same weight loss--but the whole grain group had lost more belly fat, and had a 38% decrease the their C-reactive protein levels (inflammation marker).  The magnitude of the this C-reactive protein reduction was similar to the reduction achieved with statins.   
• Why do we want to eat foods that discourage belly fat--and that will down-regulate the genes in our belly fat?  Belly fat is completely different from the subcutaneous fat that surrounds our bodies. It's called omentum, and it acts just like an organ, secreting its own chemicals and hormones like adipokines that produce angiotensin II, that raises blood pressure. It also secretes tumor necrosis factor, interleukin 6, and C-reactive protein which lead to high blood pressure, insulin resistance, high cholesterol and inflammation that damages our brains & blood vessels. To read more about why you want to ditch the belly fat, click here.
• How do I find out which foods are low-glycemic?  The University of Sydney maintains the most reliable database.  Look for foods that have a glycemic index of 55 or under.  Click Here for the database.  Click Here for their excellent newsletter. Bottom line: you want very grainy "kibbled" least-processed breads & carbs that move slowly through your digestive system.

Why Exercise Matters If You Want to Keep Your Weight Off Forever!

The best data out there on the effect of exercise on weight loss comes from the National Weight Control Registry that was started in 1994 by Dr. James Hill and Dr. Rena Wing in Denver, Colorado.  The registry tracks over 5,000 people who have successfully lost an average of 60 pounds and have successfully kept it off for 5 years or more.  It aims to find out why these people are successful at keeping their weight off.

• The most powerful predictor of successful long-term weight loss is movement!  aka Exercise.
• On average people who have successfully maintained their weight loss, burn off 2800 calories a week which is quite a lot. 
• The calorie burn comes mostly from walking, 11,000 steps a day (that's 5.5 miles), and a higher intensity exercise for 2 days/a week--at an average of 6 METS--which is about an hour of jogging, bicycling, tennis or aerobics.  800 calories of the 2800 were burned as high intensity exercise.
• The exercise doesn't have to be in the form of long workouts--like 60-90 minutes at the gym.  People who had multiple short bouts of exercise on more days lost more weight and achieved similar cardiovascular benefits.

What Nutritional Supplements Can Help with Weight Loss and Reduce My Cardiovascular Risk?

It turns out that Metabolic Syndrome is tremendously impacted by the quality of our diet.   We are now beginning to understand that the phytonutrients in our food--which have nothing to do with calories or weight loss--are metabolically active, and have profound  effects on our signaling systems--and work through the same kinase systems that pharmaceutical drugs work on.

These phytonutrients can affect the insulin-signaling pathways which are closely linked to the inflammatory pathways in our body.

Here are a few examples of some of these active dietary phytonutrients:

• Green tea
• Ginseng
• Cinnamon
• Resveratrol
• Hops - used as the bitter flavoring for beer
• Cocoa

What happens when you add phytonutrient supplements to a high quality Mediterranean Diet?  Magic!!

Dr. Robert Lerman compared two groups of dieters on a super healthy Mediterranean diet high in omega-3s, low glycemic carbs, high quality proteins, and fruits and vegetables for 12 weeks.  One study group was supplemented with the phytonutrient hops (rho-iso-alpha acids) and an extract of acai berries.

Here's how the groups compared after 12 weeks:

• Resolution of Metabolic Syndrome:  43% of the phytochemical group vs. 22% of the diet only group
• Reduction of Framingham 10-year risk scores  dropped by 5.6% in the phytochemical group vs. 2.9% in the diet only group
• Weight loss was the same in both groups
• LDLs were reduced by 17% in the phytochemical group vs. 8.4% in the diet only group
• HDLs were increased by 7% in the phytochemical group vs. 3% in the diet only group
• Triglycerides dropped by 35% in the phytochemical group vs. 14% in the diet only group

Take away point:  The optimum way to use phytochemicals is to consume them as part of a healthy diet in whole foods (think lots of fruits & vegetables), rather than thinking, "I'll just go the health food store & buy some rho-iso-alpha acid pills & then just keep eating my regular diet."  I don't think so.

According to Alger-Mayer, diets high in saturated fat have a negative effect on those protein kinase pathways, and just may wash out the beneficial effects of these phytochemicals.

What Other Whole Food Phytochemical Supplements Does Alger-Mayer Recommend?

Resveratrol

This is the phytonutrient found in the skins and seeds of grapes and of course, in wine. 

• It's known to reduce cardiovascular risk by lowering blood pressure.
• It improves endothelial function (the lining of blood vessels) by increasing that "magic gas" nitric oxide--which makes blood vessels flexible and improves dilation.  Nitric oxide production increased 3-fold in endothelial cells that were "incubated" in red wine.
• It decreases blood platelet aggregation, which means less clumping and clotting
• It's known to activate cell proteins that prevent cell death in bacteria--suggesting a "possible" increase in human longevity.  Who knows?

Cocoa

The Greek name for cocoa means, "Drink of the Gods".  Maybe they were on to something.  Epichatechin is the polyphenol in cocoa that does its magic on the cardiovascular system.

• It lowers blood pressure
• It reduces insulin resistance and improves platelet function
• It increases nitric oxide production--that "magic gas" that improves endothelial function, and it has anti-oxidant and anti-inflammatory properties.
• In a recent meta-analysis in the journal Circulation, 75 grams of dark chocolate for 3 weeks increased HDLs by 14% and decreased LDL oxidation. Lowering blood pressure took even less cocoa to do the job.
• How does cocoa do all this?  It's probably because it increases the availability of nitric oxide, and it also increases arginase--which prevents nitric oxide from breaking down.  It's a 2-for-one!
• Cocoa's best benefit?  It inhibits the kind of inflammation that creates atherosclerotic plaque.
• This study will give you a good reason to drink cocoa daily.  One of the tests for a healthy vasculature is the ability of our blood vessels to dilate.  This study looked at the dilation of arteries after drinking a high flavanoid cocoa drink, compared to a low flavonoid drink.  There was a significant increase in vasodilation with the high flavonoid drink--and nitric oxide levels increased as the level of flavonoids in the cocoa increased.
• Watch out!  Avoid cocoa or dark chocolate that is "Dutch-Processed" or is treated with an alkali to decrease its bitterness--that destroys the flavonoids!

What Does Stress Have to Do with Diet and Weight Loss?

Plenty!  Stress decreases leptin---and low levels of the hormone leptin will increase food cravings even if you aren't hungry.  Stress also increases ghrelin---the hormone that keeps you eating even when you aren't hungry.

Alger-Mayer says that stress reduction is a key factor in managing our food intake--and it even plays a role in our ability to exercise.

What effect does cortisol have on weight loss?

• Stress increases cortisol, which increases the likelihood  of snacking--especially high calorie snacks. 
• It increases belly fat
• Cortisol increases significantly in women who are "high stress reactors"--snacking is strongly associated with daily stressers in women who are "high stress reactors".
• Cortisol-Abdominal Fat Connection. Men & women with a high waist-to-hip ratio had greater cortisol release when under stress than those with a low waist-to-hip ratio--suggesting the release of cortisol in response to stress contributes to abdominal fat.  Click here for a waist-to-hip calculator & chart.
• Rats fed a high-fat, high sugar diet and exposed to long-term stress had a 50% increase in visceral (belly) fat

Top ways to reduce stress

• Exercise.  It reduces stress, anxiety, depression, and raises dopamine--the feel good brain chemical--which may also reduce the craving for high fat, high sugar foods.
• Many of Alger-Mayer's patients tell her that when they exercise they are better able to stick to their meal plan and avoid cravings.  When they get knocked off track, their cravings come back.
• Turns out that wheel-running in rats is a protection against stress, anxiety, and depression.  It also affects their serotonin and noradrenaline (fight or flight hormone) levels, and increases their dopamine--the feel-good hormone.
• Exercise is actually an antidote for high sugar intake!
• How deep breathing helps reduce stress.   Try the "mini"--a simple technique developed by Dr. Herbert Benson, an interventional cardiologist who founded the Mind-Body Institute at Harvard.
• Within one minute of deep breathing you increase the calming parasympathetic system kicks in, the heart rate drops, blood pressure drops, and "yeah",  cortisol drops, too.
• Here's how to do it.  Take a deep breath, expanding into the abdomen.  Hold it for the count of 4, and breathe out.  Repeat.  Doing this simple technique when you start to feel stressed may reduce cortisol, and prevent our cells from being bathed in cortisol, increases our risk of belly fat. To learn more about Benson's technique's click here.
• Figure out a step-by-step plan.  Be clear & specific.  When will you eat?  When will you walk or exercise?  How long?  Find an exercise and diet buddy.  Alger-Mayer recommends Spark People--an online weight-loss community to help you find a group with similar ages and goals as yours.
• Get enough sleep!  Less than 6.5 hours of sleep causes increased hunger, impairs glucose tolerance.  Alger-Mayer suggests going to sleep 20 minutes earlier to start.
• Give yourself rewards for your diet or exercise success.

What am I now going to change after my "appointment" with Dr. Sharon Alger-Mayer? 

• I'm definitely going to to think twice about eating any high-glycemic carbs.
• I'm going to try very hard to get at least 7.5 hours of sleep.
• I'm going to program the free step counter I got from my workplace--and start using it.  I wonder how many steps I'm walking a day?
• I'm going continue with my daily cup of cocoa.
• I'm going incorporate Benson's mini's--the deep breathing technique--as needed.
• And that's enough for now!

Please let me know what you think of this summary.  I really appreciate feedback!

 

Comments

[Ellen MacDonald]

Dear Librarian,
Thank you so much for your information. Your posts are truly inspirational, very informative and helpful. Loved the music links, now drinking cocoa with cinnamon and cayenne and trying to walk more every day. Please keep it up!

Ellie

[Maria]

Dear Libriarian,

Thank you so much for your informative posts. I smile everytime I see your posts in my inbox. I recommend your blog as often as I can. You have made a difference in my life and the lives of many others since I share your information with many people.

Please keep writing. You are truly helping people.

Gratefully yours,

Maria

[Trying hard in Vermont]

Dear HHLL,
You are quite amazing!I am a true devotee and plan on reading backwards through all your postings since the beginning. Today's post was chock full of the most helpful information. I truly appreciate how clearly you filter the research so we can all understand and benefit from it. The one thing I'd like to add is a breathing/stress relief exercise I learned long ago from Dr. Andrew Weil. When I feel anxious or if I can't fall asleep, I always find great success with his technique called 4-7-8:
http://www.drweil.com/drw/u/ART00521/three-breathing-exercises.html
it's the second exercise listed here. I plan on reading this current post again and checking my GI foods! Thanks again for all your dedicated work and your sharing!

[Claudia Kay]

You are a Godsend!
I think I had seen an intelligent comment you made on a NY Times article, and that is how I discovered you. I signed up for your e-mail, and never got anything. And now this wonderful, humorous, inspiring article.
Thank you, thank you, thank you!
I haven't digested the article, yet -- just a quick look through. But I take exception to your final comment: "And that's enough for now!" Can there ever be enough when one's health and life are at risk? Maybe say: "And I'll count my blessings when I go to sleep."
Again, thank you, thank you, thank you!

[Carol]

Love this piece (and this blog)!
I did notice that in Dr. Ludwig's editorial, he included oats in the high insulin response group along with wheat and potatoes, yet you mention it in with the low GI foods like quinoa and beans - am I missing something? I did think oats were fairly high in the GI Index ...

Thanks!
Carol

[barbie friedman]

Hello,
I'm day by day implementing a bit more of healthy eating into my diet. You've mentioned the last several weeks about the value of 70% cocoa, and I'd like to be able to add some to my TJ's non-fat Greek Yogurt- it would be easiest to just add in the cocoa powder- But is there 70% cocoa powder? I seem only to be finding it in bar form-
Thanks for the awesome information you send out way!

[The Healthy Librarian]

Carol,

Here's the thing--I left out the detail about "oatmeal" bread because it was confusing--but good detective work--you tracked it down.

Processed oatmeal bread is high-glycemic, just as is instant oatmeal.

Anything 55 and under is low-glycemic.

Unprocessed oats are low-glycemic. Steel cut oats (my personal favorite) are rated as 42. Rolled oats (the kind you have to cook) are rated at 50.

Hope this clears things up.

[The Healthy Librarian]

Hi Barbie,

You definitely want to use cocoa powder--it's 100%, no added sugar or cocoa butter. You want to be sure that the label says "natural" and that it is NOT Dutched, or uses alkali--which is used to get rid of the bitter taste.

The richest tasting--and the most expensive cocoa is from Scharffen Berger. Next comes Ghiradelli, and then Hershey's Natural unsweetened. There are probably other fancy brands, but I haven't seen or tasted them. The ingredients on the label should only list cocoa.

The best part of using cocoa is that the calories are low, because there is no fat.

I prefer Pacific Hazelnut milk to almond milk for hot cocoa--but try the yoghurt mix.

Here's the super high ORAC antioxidant rating of unsweetened undutched cocoa:

It has an impressive ORAC score of 80933 per 100 grams or 3.5 ounces. That works out to about 23,124 per ounce (28g) or 3854 per tablespoon. Compare that to an orange at 1,819

Hope this helps.

[The Healthy Librarian]

Thank you everyone for your very very kind words and wonderful feedback! It always makes my day and is so appreciated!

Vermonter--thanks for the Dr. Weil 4-7-8 breathing exercise link. It's an excellent instruction, and I recommend folks check it out. I've done this occasionally in yoga classes and it's so relaxing. Great idea to try it when it's hard to sleep.

Claudia,

You are right! And I really do count my blessings, daily!!! Sorry if I sound cavalier.

[Cynthia Bailey MD]

I found you through the New York Times' Well Blog where you posted a very thoughtful and information rich comment. Your blog has the same qualities. Wow, this post is right on the money and very solidly backed up by science. You've put together the puzzle pieces for exercise, belly fat, diet, stress reduction and overall health in one excellent post. Your hitting all the points that I've found to be true in my own experience, and you've explained them in a way that's accessible to lay readers using expert sources. Well done!
Cynthia Bailey MD
http://www.otbskincare.com/blog/

[Andrea]

Love it too as so many readers before as it sums up quite scientific evidence is a quite easy package and really inspires to take on some of the ideas in your daily routine.

Thanks

[Brin]

As always, I am blown away by the quality of the writing and the distillation of concentrated information. What a fantastic post--so useful and so well researched! I'd need a thesaurus to tell you how much I enjoy your blog. Thank you so much for what you do! It really is appreciated.

[The Healthy Librarian]

Brin,

WOW is all I can say! You really know how to make a librarian feel good! You've made my day.