Browncast Episode 28: Obesity, Lifestyle, Fat and more..

Another BP Podcast is up. You can listen on LibsyniTunesSpotify,  and Stitcher. Probably the easiest way to keep up the podcast since we don’t have a regular schedule is to subscribe at one of the links above.

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In this episode Razib and Omar move away from politics and culture to talk about the science (and non-science) of nutrition, lifestyle, obesity and fatness, especially as it relates to South Asians.  As some readers may know, I am an endocrinologist with a research interest in obesity and insulin resistance and Razib is a geneticist with a personal interest in health, nutrition and lifestyle, so I hope listeners will find it useful. Comments welcome.

PS: a couple of people have asked what my recommendations are for treating obesity. I hope to do a longer post some day, but here is the brief outline of what I advise my (pediatric) patients:

-Increased physical activity (1 hour of moderate to vigorous daily activity that gets your heart rate up; minimum of 30 minutes per day). This can be as simple as taking a brisk walk or using a treadmill or going up and down the stairs or dancing in front of a video or playing activity games on a game console.
-Try to adopt a lifestyle in which most meals are home-cooked and consist primarily of fresh ingredients rather than processed foods. Try to limit overall caloric intake and I especially recommend limiting the intake of carbs (smaller helpings of pasta, rice, bread, potatoes, more of fresh veggies and meats that are not heavily breaded or fried; for significantly obese patients I recommend limiting carbs to 2 servings per meal (30 grams of carbs) and no carbs in snacks). That said, each person can find a lower calorie, lower sugar diet that they are most comfortable with. As long as it is helping them lose weight, it’s good.
-Eat fruit rather than drink fruit juice. Increase your intake of fresh vegetables and eat whole grains rather than highly refined ones. This may not have much impact on weight per se, but will improve cholesterol, cure constipation and may have other health benefits.
-Avoid all chips, Cheetos and other high-calorie snacks. Stop buying these snacks, stop eating them except on rare occasions. 
-Limit foods made with added sugar (cookies, brownies, donuts, cakes, pastries, candy, etc.) to small helpings on special occasions. Limit fast food intake to occasional outings.
-Stop the regular use of soda, gatorade, powerade, iced tea and juice, try to drink more water at meals.
-Avoid all foods that contain trans fats (read labels).
-Most studies indicate that dairy is good for you and drinking 1-2 cups of milk daily is strongly recommended for all children and adolescents. Yogurt is good for you, and cheese (in moderation) is also beneficial rather than harmful. There is evidence that whole fat dairy products may be healthier than low-fat alternatives for most people.
-Nuts, avocados and lentils appear to be healthier than equivalent amounts of other foods and eating them in moderation may have long term health benefits in addition to helping with weight loss.

-Limit screen time. (the official advice is <2 hours daily, but the fact is that most students spend more than that on just work, but limit as much as possible, set up “phone-free time” for physical activity and other social interactions.  

Finally, do NOT make a constant struggle over dieting and weight control the dominant feature of your child’s life. A healthy lifestyle for the whole family is the aim, rather than obsessive control of one child’s food intake.
-Do not be discouraged if weight loss is slow. Your body will always resist weight loss; the aim is to stick to an overall healthier lifestyle (more exercise, less processed foods, few snack items, more fresh foods)

7 Replies to “Browncast Episode 28: Obesity, Lifestyle, Fat and more..”

  1. Dr. Ali will hate me for this…Endocrinology was one of my least favorite rotations, just because the knowledge base required for it is pretty much completely different from that required for Inpatient IM, at least from an Intern’s perspective.

    Still looking forward to the podcast, though.

  2. Is it a healthy habit to do BP commenting with a glass of red, at least that multitasking saves some time? Are two glasses too much? What is the impact on cholesterol and heart? Is it recommendable to stick with red only or occasionally can be switched to white?

  3. Have not yet listened to this podcast.

    I would note that with large data sets obesity is strongly negatively correlated with career outcomes and socio economic outcomes.

    Some possible reasons for this include:
    —obesity is negatively correlated with physical health which in turn is correlated with socio economic outcomes
    —employers, customers, suppliers, investors, partners, collaborators, employees, stake-holders, life partners discriminate on the basis of obesity
    —obesity is correlated with mental health because of self confidence issues
    —other causes

    Whatever the reasons are, physical fitness and not being overweight is one of the best poor and lower middle class people empowerment methods we know about.

    For this reason I suggest a type of specialized modified UBI. Every citizen would get a sensor to track their exercise. They would be paid to exercise. Their compensation would be determined by what the sensors measure. Simultaneously every citizen would get a voucher for gym/swimming pool/Yoga studio/Tai Chi Qi Gong studio etc. This voucher could “ONLY” be used for this purpose [similar to school vouchers].

    Plan a much longer policy article on this subject.

  4. Here is how I comfortably lost >15 unwanted pounds recently. For the entire day the basic meal content is 100 grams of sprouted lentils (whole rinsed lentils of any kind soaked at ambient temperature, rinsed, allowed to grow ~ 1/2 day, cooked by boiling until most loose hulls are easy to wash away) + (plus) 50 grams of whole grain rice (I hapoen to have a red SriLankan variety, soaked 24 hours at warm temperature of about 32 – 36°C, rinsed, allowed to “grow” ~ 1/2 day & then cooked in adequate water of about 250 ml water).

    This was the core part of my daily diet; I am 6 feet tall. In practise these germinated ingredients (100 gr. dry weight lentil + 50 gr. dry weight rice) cooked were divided in equal parts for the main meals of mid-day & evening; if needed reheated in a microwave. Each serving was garnished with whole milk cheese (like paneer), varieties of cooked vegetables (like eggplant) & pickles (like bitter melon).

    The germination increased GABA content (although cooking methods impact GABA) & I think this helped with meal satiety. Breakfast was whole milk curd & a teaspoon of honey. My only exercise was slighly vigorous & prolonged (~ 1 hour) walking.

    No food was eaten later in the evening, nor inter-meal grazing. And I stopped staying up late & getting exposed to home electronics’ blue light.

    [Proper sleep pattern allows liver to sustain ideal gene expression of rhythmic changes during day & also avoids non-rhythmic genes shifting to become expressed in unwanted rythmic manners. When there is down-shifted gluco-neo-genesis internally making glucose there is too sparse glycerol of the regularly spun off by lipid/fat cleaving being used; which in turn impacts the natural daily tri-glycerides’ rhythmic changes. An out of synch liver is storing more glycogen/glucose & when that glycogen/glucose is expended the out of synch liver’s low gluco-neo-genesis pattern results in the body being signaled to eat for glucose; it is a paradigm that causes the bodies internal leptin hormone level to stay low & the satiety signal functions improperly. In contrast, by eating at our natural archaic human times the liver gene expression pattern is coordinated with: there is liver glucose uptake & “sugar” cleaving glyco-lysis for our bodies’ energy use; then naturally followed later on into our traditional time of sleep by internal glucose synthesis via gluco-neo-genesis for blood “sugar” glucose when we arise. ]

    Now that I have been weighing in the morning under 170 pounds for a while I find that some days I can overload on calories (like fancy dosas or ice cream), gain a few pounds & then lose that promptly. Although my total cholesterol has not numerically changed there has been significant reduction in the number of LDL particles that are of the small (oxidation prone, undesirable) size. [By the way, oxidized LDL subsequent from a legume dietary source has a shorter half-life than oxidized LDL subsequent from a meat dietary source.]

    Once I got in the rhythm of a cyclic germination the strategy has become quite routine; the cooking is not messy either. In a few hours I will be off-line for awhile & figured this may intetest some. I apologize in advance for not being able to respond to any comments or professional disagreements with what I’ve written.

  5. Synopsis: Alleviated BPH (Benign prostatic hyperplasia) by squatting exercises and urinating while squatting. Control Diabetes by lots of (6 hrs) of physical work. Nno medications for either condition.

    In Apr 2012 I found that I had high sugar (500mg/dl) and BPH (Benign prostatic hyperplasia).

    The issue with BPH is that you have to urinate often and very little each time. I could not travel from Colombo to Puttalam without getting off the bus twice, in a 3 hour ride.

    When I was diagnosed, with Diabetes (Type 2) and BPH, started taking medication.
    For the Diabetes: Metformin (2x500mg) and Gliclazide 3 times a day
    For BPH: Urimax (tamsulosoin) and Finast (Finasteride) twice a day.

    http://wilpattuhouse.blogspot.com/2017/09/diabetes-and-bph-my-experience.html

      1. Xerxes

        Squatting is not possible in Westernized places where a sit down commode is the norm. Plus in the Euro centric thinking, squatting (to pee etc) is considered the woman’s way. I have had some doctors say, squatting may cause hemorrhoids.

        The Koran says for men to squat and pee.
        The Laws for Buddhist Monks (Vinaya Pitaka, part of Tripitaka) also says to squat and pee.

        They seemed to have been obsessed with Toilets
        http://sdhammika.blogspot.com/2008/10/ancient-toilets.html

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