Fit AND Fat?

On January 7, 2010, in Uncategorized, by Andrea

The usual standard of fitness, the BMI, or Body Mass Index chart, is a crappy indicator.  We all know this.  I mean, anything that puts celebrities like Arnold Schwarzenegger in the “obese category” is not a good indicator of health.  So this is a big “duh” for many of us.

But I always said I had been a “healthy” fat person.  And given my lack of co-morbs prior to surgery, I was.  I had low blood pressure, no signs of heart disease, low cholesterol, no diabetes — even LOW blood sugar rather than trending upward sugar levels, no sleep apnea, no PCOS — but would I have stayed that way?

So again, is there a question of Fit, but Fat?

It’s interesting to me that there were two different things about this — both from two different countries, studying two different genders, that say the complete opposite of each other.  Now given, one is a short-term glimpse of life and one is a long-term study.  I’m more apt to look at the long-term study, but the video does bring in the relevance of waist circumference versus BMI (although I’m not certain it would have made a difference in either case), but it does bring the point home that a different measure should be made.

From Medscape:

Overweight, Obesity up CV Risk Regardless of Metabolic Markers in Long-Term Study

Michael O’Riordan

January 5, 2010 (Uppsala, Sweden) — Middle-aged men with the metabolic syndrome are at an increased risk of cardiovascular disease and death regardless of their body-mass index (BMI), new research shows [1]. On the flip side of that combination, investigators also showed that overweight and obese individuals without the metabolic syndrome are at an increased risk of cardiovascular events and death.

Publishing their results online December 28, 2009 and in the January 19, 2010 issue of Circulation, Dr Johan Ärnlöv (Uppsala University, Stockholm, Sweden) and colleagues say the “data refute the notion that overweight and obesity without the metabolic syndrome are benign conditions.”

As the researchers note in their paper, previous studies have shown that obese individuals without the metabolic syndrome–sometimes referred to metabolically healthy obese, or even healthy fat–were not at an increased risk of cardiovascular disease events. Follow-up in these studies was around 13 years, leaving some question as to the long-term impact of different BMI/metabolic-syndrome combinations.

In this new Swedish examination, cardiovascular risk factors were assessed in 1758 middle-aged individuals without diabetes in the Uppsala Longitudinal Study of Adult Men (ULSAM). During a median follow-up of 30 years, 788 participants died and 681 developed cardiovascular disease. In hazard models that adjusted for age, smoking, and LDL cholesterol, metabolic syndrome was associated with an increased risk in normal, overweight, and obese individuals. As noted, even obese and overweight individuals without metabolic syndrome were at an increased risk for death and cardiovascular events.

ULSAM: Death and Major Cardiovascular Events (HR, 95% CI) in the Different Groups

End point Normal weight without metabolic syndrome Normal weight with metabolic syndrome Overweight without metabolic syndrome Overweight with metabolic syndrome Obese without metabolic syndrome Obese with metabolic syndrome
Total death Referent 1.28 (0.90–1.82) 1.21 (1.03–1.40) 1.53 (1.19–1.96) 1.65 (1.03–2.66) 2.43 (1.81–3.27)
CV death Referent 1.77 (1.11–2.83) 1.44 (1.14–1.83) 2.19 (1.57–3.06) 1.20 (0.49–2.93) 3.20 (2.12–4.82)
Major CV events Referent 1.63 (1.11–2.37) 1.52 (1.28–1.80) 1.74 (1.32–2.30) 1.95 (1.14–3.34) 2.55 (1.82–3.58)

The researchers note that there appeared to be a lag time of approximately 10 years before the Kaplan–Meier curves for overweight and obese individuals without the metabolic syndrome diverged from the curve of normal-weight participants without the syndrome.

“This could be important, because it is possible that the transition from overweight/obesity without metabolic derangements to overt cardiovascular disease is a pathological process that spans several decades,” write Ärnlöv and colleagues.

They note that based on previous studies, weight loss in these so-called metabolically healthy obese and overweight individuals had been questioned, with some researchers even suggesting it might be harmful for them to lose weight. Based on their results, however, the “potential benefits of diagnosing metabolically healthy obese in clinical practice appears limited,” and the data do not support the existence of a healthy obese phenotype based on the absence of metabolic syndrome or insulin resistance.

And conversely, from MSNBC.com:

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Heart Disease to cost US $503 Billion in 2010

On December 18, 2009, in General Nutrition, by Andrea

Looks like another reason to have WLS…

From MSNBC

Heart group says many cases could have been prevented

WASHINGTON – Cardiovascular disease and stroke will cost the United States an estimated $503.2 billion in 2010, an increase of nearly 6 percent, and many cases could have been prevented, the American Heart Association said on Thursday.

The figure includes both health care costs and lost productivity due to death and disease, according to an update published online in the journal Circulation.

The heart association says obesity and other risk factors, like too little exercise and poor diet, are fueling the expected increase in health care costs associated with heart disease and stroke.

Story continues below ↓

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“Current statistical data show Americans to be on average overweight, physically inactive and eating a diet that is too high in calories, sodium, fat and sugar,” said Dr. Donald Lloyd-Jones, head of the American Heart Association Statistics Committee.

Lloyd-Jones, a cardiologist at Northwestern University in Chicago, said too many people do not take cholesterol-lowering medicines that could lower their risk.

“One reason it will cost us more to treat tomorrow’s patients is because there will be more of them if current trends continue,” Lloyd-Jones said in a statement.

According to the heart association, 59 percent of adults who responded to a 2008 national survey described themselves as physically inactive.

The report also says fewer than half of people with heart disease symptoms are receiving cholesterol-lowering drugs, like statins.

Heart disease is the No. 1 killer of men and women in the United States and in most industrialized countries. According to the World Health Organization, cardiovascular diseases and diabetes accounted for 32 percent of all deaths globally in 2005.

The heart association said the number of inpatient cardiovascular operations and procedures jumped 33 percent from 1996 to 2006, from 5.4 million to 7.2 million.

By 2020, the American Heart Association hopes to reduce U.S. deaths from cardiovascular diseases and stroke by 20 percent.

“To reach the 2020 goals, Americans must start making healthier lifestyle choices,” Lloyd-Jones said.

Copyright 2009 Reuters.


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Vitamin D Newsletter — December 3, 2009

On December 3, 2009, in Fat Solubles, Pregnancy after WLS, by Andrea

The Vitamin D Newsletter

More Vitamin D Studies of Interest

December 3, 2009.


This is a periodic newsletter from the Vitamin D Council, a non-profit trying to end the epidemic of vitamin D deficiency. If you want to unsubscribe, go to the end of this newsletter. If you are not subscribed, you can do so on the Vitamin D Council’s website.

This newsletter may be reproduced as long as you properly and prominently attribute it source. Please reproduce it, post it on Internet sites, and forward it to your friends.


Five million dollar randomized controlled trial sponsored by Thrasher Research Fund and NIH

Scientists around the world presented their work at the recent Vitamin D conference in Brugge, Belgium. Many, but not all, of the scientists opined that we have to wait for randomized controlled trials (RCT) before recommending Vitamin D. In a future newsletter, I will review many of these presentations.
However, one was extraordinary. Professor Bruce Hollis presented findings from his and Carol Wagner’s five million dollar Thrasher Research Fund and NIH sponsored randomized controlled trials of about 500 pregnant women. Bruce and Carol’s discoveries are vital for every pregnant woman. Their studies had three arms: 400, 2,000, and 4,000 IU/day.
1. 4,000 IU/day during pregnancy was safe (not a single adverse event) but only resulted in a mean Vitamin D blood level of 27 ng/ml in the newborn infants, indicating to me that 4,000 IU per day during pregnancy is not enough.
2. During pregnancy, 25(OH)D (Vitamin D) levels had a direct influence on activated Vitamin D levels in the mother’s blood, with a minimum Vitamin D level of 40 ng/ml needed for mothers to obtain maximum activated vitamin D levels. (As most pregnant women have Vitamin D levels less than 40 ng/ml, this implies most pregnant women suffer from chronic substrate starvation and cannot make as much activated Vitamin D as their placenta wants to make.)
3. Complications of pregnancy, such as preterm labor, preterm birth, and infection were lowest in women taking 4,000 IU/day, Women taking 2,000 IU per day had more infections than women taking 4,000 IU/day. Women taking 400 IU/day, as exists in prenatal vitamins, had double the pregnancy complications of the women taking 4,000 IU/day.
What does this huge randomized controlled trial mean?
We have long known that blood levels of activated Vitamin D usually rise during very early pregnancy, and some of it crosses the placenta to bathe the fetus, especially the developing fetal brain, in activated vitamin D, before the fetus can make its own. However, we have never known why some pregnant women have much higher activated Vitamin D levels than other women. Now we know; many, in fact most, pregnant women just don’t have enough substrate, the 25(OH)D building block, to make all the activated Vitamin D that their placenta wants to make.
Of course fetal tissues, at some time in their development, acquire the ability to make and regulate their own activated Vitamin D. However, mom’s activated Vitamin D goes up very quickly after conception and supplies it to baby, during that critical window when fetal development is occurring but the baby has yet to acquire the metabolic machinery needed to make its own activated Vitamin D.
The other possibility, that this is too much activated Vitamin D for pregnancy, cannot stand careful scrutiny. First, the amount of activated vitamin D made during pregnancy does not rise after the mother’s 25(OH)D reaches a mean of 40 ng/ml, so the metabolism is controlled. Second, levels above 40 ng/ml are natural, routinely obtained by mothers only a few short decades ago, such as President Barack Obama’s mom probably did, before the sun scare. (President Obama was born in Hawaii in late August before the sun-scare to a mother with little melanin in her skin) Third, higher blood levels of Vitamin D during pregnancy reduce risk of infection and other pregnancy complications, the opposite may be expected if 25(OH)D levels above 40 ng/ml constituted harm.
It is heartening to see the Thrasher Research Fund and NIH support such a large randomized controlled trial. In fact the Thrasher Research Fund has already funded a three year follow up and the NIH request for a follow up grant is pending. Nevertheless, a large number of medical scientists keep saying, “We need even more science before recommending Vitamin D.” What are they really saying?
First they said we need randomized controlled trials (RCT) before we do anything. Well here is a big one. Then they say, as they did in Brugge, “We don’t believe this RCT, we need more money for more RCTs.” If you think about it, they are saying pregnant women should remain Vitamin D deficient until scientists get all the money for all the RCTs they want, which may take another ten years. How many children will be forever damaged in that ten years?

Amazing study just presented at American Heart Association meeting
Dr. Tami Bair and Dr. Heidi May, of the Intermountain Medical Center in Utah, report yet another study showing that your risk of heart attack, stroke, congestive heart failure and death are dramatically increased by Vitamin D deficiency. In a presentation at the American heart Association meeting, they found that people with low levels (< 15 ng/ml) had a 45% increased risk for cardiovascular disease, 78% greater risk of stroke and double the risk for congestive heart failure, not to mention a 77% increased risk of death, compared to people with Vitamin D levels > 30 ng/ml. All that disease and death occurred in only 13 months of follow up for the 27,000 people in the study.
So how many Americans died this last year from Vitamin D deficiency? Ten thousand? A hundred thousand? More? How many will die next year? Someone is responsible. Medical scientists who want more money before recommending that Vitamin D deficiency be treated have to assume responsibility. I am all for more studies but we have to act now, like we did with cigarettes. Remember, no human randomized controlled trials exist showing cigarettes are dangerous, so we have much more and better science than we did when we warned about smoking. If we fail to act on the dangers of Vitamin D deficiency, someone will end up with blood on their hands.

The Great Disappearing Act
We are currently witnessing one of the great mysteries of the natural world. The H1N1 outbreak is rapidly disappearing, despite a wealth of potential victims without antibodies to the virus, and yes, in spite of plummeting Vitamin D levels. In several weeks, the CDC will announce that perhaps one-third of Americans were infected in the last nine months and now have Swine flu antibodies, leaving the majority of the population still susceptible.
But this H1N1 virus is rapidly refusing the invitation to infect the two-third of Americans who are mostly immunological virgins and will soon recede until the next widespread outbreak, which may come this spring or next fall and winter. When H1N1 returns again, I predict it will cause more illness and death than it did this fall despite the fact it will attack a population with more H1N1 specific antibodies. Measles, another virus thought to transmit via respiratory secretions, would never forego the opportunity to infect so many virgins.
Influenzologists have no idea why this Disappearing Act happens. Dr. Edgar Hope-Simpson believed the reason lay in the mode of transmission; the current outbreak is ending despite a wealth of potential victims because the people transmitting the flu are suddenly no longer contagious. I recommend Hope-Simpson’s book:
I also believe that only a small population was transmitting, not all those infected. If these good transmitters – and not all the sick – usually spread the virus, and their transmission period is limited, the epidemic would end shortly after the good transmitters lose their infectivity. Why they lose their infectivity is yet another mystery, but a mystery that fits the epidemiology of influenza.
Another incredible Disappearing Act, one that usually follows the introduction of a pandemic virus, is the rapid and usually complete replacement of seasonal flu with the pandemic one. It is as if the pandemic virus murders the seasonal flu. We will have to wait to see if that happens worldwide with this pandemic, but in the USA it has already happened. Last week the CDC reported that more than 99% of all influenza viruses identified in the USA were Swine flu. Only 1 of 1,874 influenza A viruses identified last week was seasonal flu. Where did the seasonal flu virus go?

Thanks to those who volunteered!
If your email address begins with A through E, you may have gotten my email asking for volunteers to help give feedback on our new website. We were overwhelmed with the response, ten times more than we needed. Thank you.
The reason for the request is that the Vitamin D Council has contracted with Minervation Ltd for $40,000 to build a new website over the next several years. We can only afford $1,000 per month so it take three and a half years to pay them, however; the first version of the new site is scheduled to go up in the late fall of 2010.
We decided to make our site more accessible, so if you only want to know about Vitamin D and pregnancy, you will be able to pull up the information quickly. Our new website will also update Vitamin D articles in the press and scientific studies from the National Library of Medicine automatically every day.
We also want to clearly separate fact from opinion, so readers can easily see what the science is and what our opinion is. Finally, as you know, the Vitamin D Council unfortunately has to market products, like the in-home Vitamin D blood test, to stay in business. The new website will prominently display all of our potential conflicts so readers will know them up front.
If you want our new website up and running sooner than 12 months, consider making a dedicated donation, either by using the snail mail address below or via PayPal on our website. We are now going on our seventh year of operation and plan on 20 more years, in spite of the fact that all 15 of our requests for grants were recently turned down.
Did you know that when you Google “Vitamin D,” you will get more than 12 million hits? Our current website is usually ranked either number 1 or 2 of those 12 million, beating out the NIH, Mayo Clinic and Wikipedia on most days? This is almost entirely due to our webmaster Dana Clark. However, we believe we can dramatically improve our website, with your help.

John Cannell, MD
This newsletter may be reproduced as long as you properly and prominently attribute it source. Please reproduce it, post it on Internet sites, and forward it to your friends.
Remember, we are a non-profit and rely on your donations to publish our newsletter, maintain our website, and pursue our objectives. Send your tax-deductible contributions to:
585 Leff Street
San Luis Obispo, CA 93422
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More evidence for D

On November 17, 2009, in Fat Solubles, by Andrea

Via CNN.com

About time people are getting the message.  Vitamin D has been linked to everything from lowering cancer risk, stroke, heart disease, hypertension, auto-immune disorders, diabetes, and depression.

A few notables..

In the first study, May and her colleagues measured blood levels of vitamin D in 8,680 people age 50 or older who had been diagnosed with heart disease, stroke, or another type of cardiovascular disease. vitamin D levels above 30 nanograms per milliliter of blood (ng/mL) were considered normal, levels between 15 and 30 ng/mL were low, and those 15 ng/mL and below were deemed very low.

Among those with very low levels of vitamin D, 32 percent were depressed, as were 25 percent of the people with low levels, and 21 percent of those with normal levels. This trend was seen even among individuals with no history of depression.

…

In the second study, which looked at 27,686 people age 50 or older with no history of cardiovascular disease, May and her colleagues found that, compared to individuals with normal levels of the vitamin, people with very low levels of vitamin D were 77 percent more likely to die, 45 percent more likely to develop heart disease, and 78 percent more likely to have a stroke during the study, which lasted for more than a year. They also had double the risk of heart failure.

…

Holick advocates raising the daily limit to 10,000 IU. Many researchers agree and have suggested that the toxic level of vitamin D is closer to 10,000 IU/day.

Keep in mind that 10,000 IU / day number is for normies.. not for those with designer guts.

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