WEIGHT LOSS & SUSTAINED LIFESTYLE CHANGE CAN PREVENT MOST TYPE 2 DIABETES

A large randomized trial in which individuals with pre-diabetes lost weight, improved their diet quality, and maintained regular physical activity illustrates just how remarkably effective lifestyle change is in preventing pre-diabetes from progressing to diabetes. 

In the first phase of the intervention, individuals with pre-diabetes adopted an 800-daily calorie liquid meal replacement diet for two months. Participants lost a minimum of 8% bodyweight.  Following the initial period of weight loss, participants were assigned to one of four treatment groups in which subjects were instructed to increase physical activity to either 75 minutes of high-intensity exercise or 150 minutes of moderate-intensity exercise weekly and to follow either a high protein/low-glycemic index diet or a moderate-protein/moderate-glycemic index diet.  A low glycemic index diet minimizes intake of quickly digested carbohydrates such as those in sweets, refined grains, and some starchy vegetables, and instead focuses on slowly digested whole food sources of carbohydrates such as non-starchy vegetables, most fruits, whole in-tact grains, and beans.  Participants were also provided sustained nutritional and physical activity counseling.  In the study, after 3 years, of the 962 pre-diabetic patients still participating in the study, only 6% had progressed from pre-diabetes to type 2 diabetes.  There was no significant difference between the two dietary treatments nor the activity treatments.  These results highlight the fact that the vast majority of those with pre-diabetes can prevent diabetes if they maintain modest weight loss, make healthier dietary choices, and do regular activity.

Unfortunately, this study also illustrates that even when individuals’ are provided with a lot of support in adopting and maintaining lifestyle changes, many do not stick with these changes over the long-term.   Only about 1.5% of participants did not achieve the initial 8% weight loss cut-off while on the full meal replacement diet but nearly half of study participants did not finish the weight loss maintenance arm of the study.  Thus, the intervention was very effective but only if adhered to, and therein lies the tremendous challenge of behavioral change. 

What to do:  For most individuals, an effective strategy to prevent pre-diabetes from becoming diabetes is to lose a fair amount of weight and then keep the weight off while maintaining regular physical activity.  What can you do to increase your odds of weight loss maintenance?  Lost weight must be proactively defended. Frequent self-monitoring (such as journaling intake, regularly checking weight), integrating food preparation and activity into the fabric of your daily and weekly routines (such as an active commute, structured menu planning, batch cooking & freezing healthy meals), enlisting social support, doing at least 1 hour of regular physical activity daily, eating slowly and mindfully, and utilizing healthy non-food coping techniques are some of the strategies most associated weight loss maintenance.   Also, where medically indicated, bariatric surgery, while no guarantee, significantly increases one’s odds of maintaining substantial weight loss and reversing pre-diabetes. 

Information adapted from articles available at:  https://www.healio.com/endocrinology/diabetes/news/online/%7B996c7f17-b77c-4518-9270-090d2ea074dc%7D/preview-intensive-weight-loss-behavior-change-prevents-conversion-to-type-2-diabetes

https://www.mdmag.com/conference-coverage/ada-2019/preview-data-diabetes-prevention-diet-exercise

Source:

Macdonald I. Prevention of diabetes through lifestyle intervention — results from the multicenter PREVIEW study. Presented at: American Diabetes Association 79th Scientific Sessions; June 7-11, 2019; San Francisco.

NOT ALL ARTIFICIAL SWEETENERS CREATED EQUAL

Artificial sweeteners, also referred to as “sugar-free”, “low-calorie”, and "calorie-free" sweeteners are substances that taste sweet but add little or no calories to foods and beverages.  Some available  that contain almost no calories in the amounts consumed include aspartame (Equal, NutraSweet), saccharin (Sweet n Low), stevia leaf extract (rebaudioside A, with brands including PurVia, Truvia), monk fruit, and sucralose (Splenda).  Sugar-alcohols such as xylitol, sorbitol have about ½ half the calories of sugars.

While there is solid evidence that intake of full-calorie sweeteners including  table sugar, syrup, fruit juice concentrate, corn syrup, and many others  increases risk of weight gain, insulin resistance and diabetes, fatty liver, heart disease, systemic inflammation, and many other chronic conditions, the role of sugar-free sweeteners on weight and health continues to be a subject of much debate.  Many large observational studies have found associations between sugar-free sweetener intake and weight gain.  At the same time experimental trials have mostly found slight reductions in weight with the use of sugar-free sweeteners.    

A recent study suggests there may be significant differences in how the body responds to the different products.  A randomized controlled trial compared how intake of four different sugar-free sweeteners impacted bodyweight and found bodyweight responded differently depending on which sweetener was consumed.  For the study, 154 adults aged 18-60, who were overweight/obese but otherwise generally healthy and weight stable, were assigned to one of five experimental treatments.   Participants were randomized to drink 5-7 cups (amount varied depending on baseline bodyweight) of a beverage sweetened with one of four sugar-free sweeteners: saccharin (Sweet n’ Low), aspartame (Equal), rebaudioside A (stevia), and sucralose (Splenda), or sucrose (sugar) daily for 12-weeks. Researchers found that those consuming the drinks sweetened with sugar (containing 400-560 calories) gained the most weight, on average 4.1 lbs.  Those consuming Sweet n’ Low gained an average of 2.6 lbs. while those consuming Splenda, Equal, and stevia did not experience significant weight change.  Compared to the other treatments, the Sweet n’ Low consumers reported greater hunger.  Those in the Splenda treatment showed a significant decrease in energy intake and a trend toward weight loss though the amount of change was not statistically significant. 

What to do:  While small, this study suggests that the bodyweight impact of sugar-free sweeteners may differ depending on which sweetener is consumed and that Sweet n’ Low may potentially promote weight gain.  Particularly for diabetics and regular consumers of sweetened drinks, substituting “diet drinks” that contain sugar-free sweeteners rather than caloric sweeteners appears beneficial and outweighs the potential risks of sugar-free sweeteners. Still, in general, it is not known what impact additives and artificial ingredients have on our physiology.  There is some evidence that sugar-free sweeteners increase the appetite for sweet foods and beverages.  Most products containing sugar-free sweeteners contain a mixture of different artificial sweeteners.  While the FDA has approved the available artificial sweeteners as likely safe, some health groups suggest stevia, monk fruit, and sugar alcohols (which contain about ½ the calories of real sugars) are preferable to Equal, Sweet n’ Low, and Splenda because of potential risks of increased rates of cancer at high doses though any increased risk is likely very slight.  Also, there is some evidence that high doses of Equal can worsen mood in vulnerable individuals.    Your best bet is to develop the healthy habit of quenching thirst with beverages that do not taste sweet.     Aim for naturally calorie-free beverages like unsweetened teas, seltzer, water infused with lemon, mint, or cut-up fruit, and just plain water. 

Information adapted from articles available at:

https://www.docwirenews.com/docwire-pick/home-page-picks/low-calorie-sweeteners-increase-body-weight/

https://www.hsph.harvard.edu/nutritionsource/healthy-drinks/artificial-sweeteners/

https://www.medicalnewstoday.com/articles/325291.php

https://cspinet.org/new/201312311.html

Source:

KA Higgins, RD Mattes.   A randomized controlled trial contrasting the effects of 4 low-calorie sweeteners and sucrose on body weight in adults with overweight or obesity, The American Journal of Clinical Nutrition, Volume 109, Issue 5, May 2019, Pages 1288-1301, https://doi.org/10.1093/ajcn/nqy381

UNSCRAMBLING THE LATEST RESEARCH ON EGGS & HEART HEALTH

Americans have significantly increased egg intake over the last decade, consuming on average 3-4 eggs per week. Part of their renewed appeal stems from U.S. Dietary Guidelines that dropped the long standing recommendation to limit dietary cholesterol to less than 300mg.   However, the controversy over eggs, dietary cholesterol, and heart disease was recently reignited by a recent study that found an association between egg and dietary cholesterol consumption and higher rates of heart disease.  

Cholesterol is a waxy substance produced by the body to synthesize hormones, produce bile for digestion, make vitamin D, and maintain healthy cell walls.  Advice to limit dietary cholesterol dates back 50 years, but randomized trials conducted over the last 15 years have indicated healthy human bodies control the amount of cholesterol in the bloodstream, and can detect and adjust the body’s cholesterol production if dietary cholesterol increases or decreases.  It also appears that our systems can excrete unneeded dietary cholesterol, especially if individuals consume adequate dietary fiber.  As a result, even though yokes contain nearly 200 mg of cholesterol, there has been growing consensus that low to moderate egg intake is not significantly associated with a higher risk of CVD.  Eggs also contain nutrients that have been linked to a lower risk of heart disease.  Eggs pack 7g of high-quality protein with about half of this found in the white. Yolks also contain a significant amount of the brain-nutrient choline, plus vitamin B12 and iron. Eggs are also one of the few dietary sources of vitamin D and are a good source of the carotenoids lutein and zeaxanthin that have been linked to lower odds of macular degeneration. 

In terms of dietary drivers of heart disease unhealthy saturated and trans fats have been found to be much more significant that dietary cholesterol.  Recommendations to limit saturated fats (the fats found in meat, chicken skin, and dairy) and completely avoid trans fats (artificial fats used to manufacture baked goods, frosting, and spreads) are still in place.  Most foods high in cholesterol are also high in saturated fats.  However, some foods high in cholesterol are not high in saturated fats including egg yokes, shellfish, and liver.

The new analysis of eggs and heart disease, drawn from the pooled data of six observational studies that followed nearly 30,000 Americans for up to 31 years, found that eating 3-4 eggs per week was associated with a 6% higher risk of cardiovascular disease and an 8% higher risk of any cause of death.  And, eating at least 300mg of dietary cholesterol per day was associated with 17% higher risk of cardiovascular disease and 18% higher risk of all-cause deaths.

Experts caution that the recent analysis has many limitations that may have lead to misleading conclusions.  One shortcoming was participants' long-term eating patterns were not assessed.  Participants self-reported their typical intake at a single visit at the outset of the studies while heart health outcomes were assessed up to 30 years later.  During this time, individuals may have significantly changed their diet. So, this one snapshot may not have accurately captured their eating habits over time.

When evaluating whether or not eggs are healthy, it is also important to look at eggs not only on their own, but in context of the entire diet, especially when compared to foods they may replace.  There is widespread consensus that eggs are a better choice than options high in saturated fat (e.g. butter, pastries, cheese, bacon), refined grains, and/or sugars.  And, eggs are one of the few typical breakfast foods that are not high in carbohydrates.  A recent study illustrates one of the benefits of eating a lower carb breakfast for those with diabetes.  It found that when a person with diabetes takes a low carb breakfast their blood sugar response to meals later in the day is less pronounced than when they have a higher carb breakfast (e.g. oatmeal, cereal, toast).  To the cardiovascular system, scrambled eggs, salsa, and a 100% whole-wheat English muffin is a far different meal than scrambled eggs with cheese, sausages, home fries, and buttered white toast. 

What to do:  Even though cholesterol is still in bold on the nutrition facts labels, focus your gaze more on the amount of saturated and trans fat listed above cholesterol.  To control your blood cholesterol eat a healthy diet rich in plant-derived fats (i.e. olive oil, nuts, avocado), fruits and vegetables, whole grains, and lean proteins. Emphasize foods high in soluble fiber such as beans, oats, barley, and gummier fruits and vegetables including avocado, okra, plums, apples, oranges, green beans, and carrots.  Control your weight, exercise regularly, don’t smoke, and take cholesterol lowering medicine as prescribed by your provider.

As for the eggs, looking at the body of research on this topic, there is not strong evidence that limiting consumption of cholesterol-rich foods lowers the amount of artery-clogging LDL cholesterol that ends up in our blood. For those without heart health problems, average intake of up to 1 egg per day is likely a healthy choice.   Experts still caution diabetics and others at high risk for heart disease to be mindful of cholesterol intake.  Some advise diabetics have no more than 3-4 egg yolks weekly.  The whites, a fantastic source of lean protein contain almost no cholesterol.  Discuss dietary cholesterol intake with your healthcare provider to determine what a safe level of egg consumption is for you given your health situation. 

Sources

Chang CR, Francois ME, Little JP.  Restricting carbohydrates at breakfast is sufficient to reduce 24-hour exposure to postprandial hyperglycemia and improve glycemic variability.  The American Journal of Clinical Nutrition.  2019;nqy261.  doi.org/10.1093/ajcn/nqy261

Hu FB, Stampfer MJ, Rimm EB, et al. A prospective study of egg consumption and risk of cardiovascular disease in men and women. JAMA.   doi:10.1001/jama.281.15.1387

Jacobson TA, Maki KC, Orringer CE, et al. National Lipid Association recommendations for patient-centered management of dyslipidemia: Part 2.  Journal of Clinical Lipidology.  2015; 9 (6): S1-S122.e1. doi.org/10.1016/j.jacl.2015.09.002

Richard C, Cristall L, Fleming E, et al.  Impact of egg consumption on cardiovascular risk factors in individuals with Type 2 diabetes and at risk for developing diabetes: A systematic review of randomized nutritional intervention studies. Canadian Journal of Diabetes.  2017; 41 (4): 453 – 463.   doi.org/10.1016/j.jcjd.2016.12.002

U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015 – 2020 Dietary Guidelines for Americans; 2015.  Available at: https://health.gov/dietaryguidelines/2015/resources/2015-2020_dietary_guidelines.pdf

Zhong VW, Van Horn L, Cornelis MC, et al. Associations of dietary cholesterol or egg consumption with incident cardiovascular disease and mortality. JAMA. 2019;321(11):1081–1095. doi:10.1001/jama.2019.1572

Adapted from articles available at:

https://www.npr.org/sections/thesalt/2019/03/16/703804493/egg-lovers-new-study-finds-eating-too-many-can-increase-risk-of-heart-disease

www.sciencedaily.com/releases/2019/03/190315110858.htm

https://www.hsph.harvard.edu/nutritionsource/food-features/eggs/

https://www.hsph.harvard.edu/nutritionsource/2019/03/18/eggs-and-cholesterol-back-in-the-spotlight-in-new-jama-study/

https://www.hsph.harvard.edu/nutritionsource/food-features/eggs/

Magnesium Improves Vitamin D Absorption

A recent review builds on previous research indicating Vitamin D cannot be metabolized without sufficient magnesium levels.  Magnesium assists in the activation of vitamin D, which in turn helps regulate calcium and phosphate homeostasis.  All of these nutrients work together to influence the growth and maintenance of bones. All of the enzymes that metabolize vitamin D require magnesium, which acts as a cofactor in the processing of vitamin D in the liver and kidneys. Deficiency in either magnesium and/or vitamin D is associated with various disorders, such as skeletal deformities, cardiovascular diseases, and metabolic syndrome.

Exposure to sunlight is the primary way to get vitamin D.  Deficiency of the vitamin is common with low blood levels found in an estimated 40% of the U.S. population.  In recent years there is a growing recognition of widespread vitamin D deficiency and many providers are prescribing high doses of vitamin D to raise blood levels.  However, in order for vitamin D to be absorbed and utilized individuals also need magnesium and low levels of magnesium are also widespread with an estimated 80% of Americans not getting adequate magnesium in their diet. As a recent study emphasizes, when individuals supplement with vitamin D, it is also important to consume a diet rich in magnesium and for those with very low magnesium intake, supplementation of vitamin D along with magnesium may be indicated.

Vitamin D has many essential functions in the body.  In addition to having a major impact on bone health, vitamin D also plays a role in thyroid and immune health. Beside vitamin D utilization, magnesium also is essential to many cellular functions and is important to supporting a healthy blood pressure and energy utilization.

A recent study found that low magnesium may reduce vitamin D levels. Even when individuals are not clinically deficient in magnesium, supplementation appears to make vitamin D supplementation more effective, especially in persons whose levels have not responded well to prior vitamin D supplementation.

What to do:  Consume a diet rich in magnesium, especially when supplementing with vitamin D.  Good sources of magnesium include dark leafy greens, beans, whole grains, dark chocolate, fatty fish (salmon, for example), milk, nuts (especially almonds, cashews, and Brazil), pumpkin and sunflower seeds, bananas, and avocados. Few foods are naturally rich in vitamin D but many products such as milk, orange juice, and nutritional bars are now fortified with vitamin D.  Some of the few places vitamin D naturally occurs in the food supply include bones (such as those found in sardines), cod liver oil, and mushrooms that are dried with the gills exposed to the sun.  If you are low in magnesium and/or vitamin D discuss supplementation options with your provider.

Adapted from articles available at:

https://www.healthline.com/health-news/how-magnesium-can-help-your-vitamin-d-levels#The-bottom-line

https://www.prnewswire.com/news/american-osteopathic-association

Source:

Uwitonze AM, Razzaque MS.  Role of magnesium in vitamin D activation and Function.   J Am Osteopath Assoc. 2018 Mar 1;118(3):181-189.  doi: 10.7556/jaoa.2018.037.

SUPPLEMENTS TAINTED WITH PRESCRIPTION DRUGS OFTEN NOT RECALLED

A recent investigation found over-the-counter supplements for weight loss, muscle building, and erectile dysfunction are often adulterated with prescription medications and banned substances.  These types of supplements have been found to be responsible for a disproportionate number of the estimated 23,000 annual emergency department visits in the United States.

Supplements, unlike medications, do not have to be proven safe and effective before going to market.  The US Food and Drug Administration (FDA) only investigates supplements after adverse health consequences have been reported.  The FDA maintains a public database listing the supplements it has identified as adulterated with drugs and the actions, if any, it has taken to remove the product from the market.  This recent research report specifically found that from 2007-2016, the FDA logged 776 dietary supplements as being adulterated with prescription pharmaceuticals but that less than half of those products were recalled. And, all of these recalls were voluntary.  That means that it was recommended the manufacturers making the tainted products recall them, but it was not mandated nor enforced.  Other studies report companies often do not comply with recommended recalls and that dangerous products continue to be sold long after recalls are issued.  

Tainted supplements can be dangerous for consumers.  For example, 81% of erectile dysfunction supplements listed in the FDA’s tainted supplement database contained sildenafil, the active ingredient in Viagra. Some men cannot take erectile dysfunction drugs because their active ingredients interact dangerously with the nitrates in drugs for diabetes, high blood pressure, and high cholesterol.  The list of prescription medicines in the 776 contaminated supplements included prescription medications sildenafil and fluoxetine (anti-depressant), withdrawn medications including sibutramine (weight loss medication that increases heart health risk) and phenolphthalein (carcinogenic laxative), and unapproved drugs including dapoxetine (for erectile dysfunction) and anabolic and other designer steroids. 20% of the adulterated supplements contained two or more undeclared drugs! 

What to do:  Everyone, but especially those who are taking multiple medications or have serious health problems need to discuss supplements with their health provider before starting.  When choosing a supplement brand, look for those certified by “USP” (the U.S. Pharmacopeial Convention) or “NSF International”.  These third party organizations conduct testing on supplements to determine if what is on the label is actually in the bottle, and that the product does not contain high levels of contaminants. Websites such as Labdoor.com and Consumerlabs.com publish lists of the highest quality supplements. Also, generally, dietary supplements made by nationally known food or drug manufacturers are more likely to have been made under tighter quality controls. Supplements that contain a single ingredient have been found to be more likely to contain the amount of the ingredient advertised on the label and less likely to have high levels of contamination. Companies selling “proprietary blends” do not have to report any ingredient amounts on their labels and should be avoided.  All in all, given the risks of some classes of supplements and the general lack of evidence of their benefit, it is likely consuming a healthy diet will improve your health much more than expensive supplements.

Adapted from articles available at:

https://www.the-scientist.com/news-opinion/hundreds-of-supplements-spiked-with-pharmaceuticals-64928

https://www.sciencenews.org/article/hundreds-dietary-supplements-tainted-potentially-harmful-drugs

Sources:
Cohen PA.  Hundreds of supplements spiked with pharmaceuticals - Invited commentary.  The FDA and adulterated supplements—Dereliction of duty.  JAMA Network Open. 2018;1(6):e183329. doi:10.1001/jamanetworkopen.2018.3329

Geller  AI, Shehab  N, Weidle  NJ,  et al.  Emergency department visits for adverse events related to dietary supplements.  N Engl J Med. 2015;373(16):1531-1540. doi:10.1056/NEJMsa1504267PubMedGoogle ScholarCrossref

Tucker  J, Fischer  T, Upjohn  L, Mazzera  D, Kumar  M.  Unapproved pharmaceutical ingredients included in dietary supplements associated with US Food and Drug Administration warnings.  JAMA Netw Open. 2018;1(6): e183337. doi:10.1001/jamanetworkopen.2018.3337Google Scholar

US Food and Drug Administration.  FDA’s Medication Health Fraud Page.  Accessed 10/25/18 at:  https://www.accessdata.fda.gov/scripts/sda/sdNavigation.cfm?filter=&sortColumn=1d&sd=tainted_supplements_cder&page=1

BRAIN HEALTH: HOW TO REDUCE YOUR RISK OF DEVELOPING DEMENTIA

One in every seven Americans older than 71 years of age has some form of dementia, most commonly Alzheimer’s disease.  Currently five million people in the U.S. currently suffer from Alzheimer’s and by 2050 the cases of Alzheimer's are projected to reach 16 million.   However, new research has proven that you can do some things to reduce your risk of developing dementia.

Nutrition Tips for Keeping Your Brain Healthy

In addition managing your weight, following a heart healthy antioxidant rich diet can help to reduce the risk of dementia.  Multiple studies have found that the 'MIND' diet, significantly reduces the risk of developing Alzheimer's disease and other forms of dementia.  Researchers developed the MIND diet by reviewing the body of evidence on how different dietary factors influence brain health. The MIND eating plan combines aspects of the heart healthy Mediterranean diet with certain features of the DASH (Dietary Approaches to Stop Hypertension) diet, both of which emphasize taking in plenty of fruits and vegetables and regularly eating beans, nuts, and whole grains while limiting meat, sugar, dairy fat, and deep fried items. The MIND diet specifically calls to:

Eat More of these	Recommended Intake
Whole grains	3+ servings daily (serving = ½ cooked grains/1 slice of bread)
Nuts	Eat daily (serving = 1.5 oz or 1/3 cup)
Beans	4+ servings per week (serving = ½ cooked beans)
Fruits	Berries, especially blueberries and strawberries at least 3 times per week (serving = ½ cup)
Vegetables	Include dark leafy greens (e.g. kale, spinach, collard) plus at least one other vegetable serving each day. (serving = 1 cup leafy green or ½ cup for others)
Poultry	2+ times per week (serving = 3 oz. cooked/size of deck of cards)
Fish	2+ times per week, especially fatty fish (serving size = 3 oz. cooked/size of deck of cards)

Eat less of these	Recommended Limit
Cheese	1 serving per week or less (serving size = 1 oz. / size of 2 dice)
Butter & stick margarine	Less than 1 Tablespoon daily.  Use olive oil instead.
Sweets and sugary beverages	5 times or less per week   (serving size 100-200 calories)
Red meat	12 oz. or less per week.
Deep fried and fast food	Once per week or less

Additional Brain Healthy Lifestyle Factors

Besides eating a brain healthy diet, here are some additional tips to promote long term brain health:

Exercise, Exercise, Exercise:  Studies have shown that it does not matter what form of exercise you choose. Anything from water aerobics to hiking will work, but the frequency and intensity does matter. In fact, in one study of nearly 1500 people who were tested at midlife before displaying any symptoms of dementia and then tested again between 65-79 years of age, those who exercised at least two times each week during middle age had a significantly decreased risk of dementia development, even after all other variables were ruled out.

Doing challenging physical activity increases blood flow and oxygen to the brain, and helps to form new cells. In fact, physically active people actually have a larger hippocampus, the area of the brain that helps with learning and memory. Physical activity also produces endorphins and other “feel good” chemicals that lead to calming and improved focus. It appears that the more energy expended during physical activity, the greater the reduction of risk. Even after dementia has begun to develop, exercise can improve concentration and brain plasticity.  

Maintain a Healthy Weight:  Research indicates a strong relationship between maintaining a healthy weight and decreased risk of dementia.   Individuals who are obese, especially those with central obesity (weight in the abdominal area) appear to have higher risk for developing dementia. In one study of 6500 individuals within the Kaiser Permanente Northern California system, those with the largest abdominal measurement had three times the risk of developing dementia, compared to those with the smallest waist measurement.

Think Positively & Be Friendly: Depression is positively linked to a person’s chance of developing cardiovascular disease, which in turn is linked to development of vascular dementia.  Similarly, persons who maintain positive social relationships (spouses, family, friends, etc.) appear to have better brain health outcomes.

Control & Treat Chronic Diseases: Diabetes is linked to development of dementia. Control of preexisting diabetes and prevention of diabetes is critical to maintaining brain health.  Similarly, uncontrolled high blood pressure is also linked to the development of both Alzheimer’s disease and vascular dementia.

Get Enough Sleep: Sleep deprivation temporarily decreases levels of brain-derived neurotrophic factor, which is crucial for storing information.  Many studies have also found a correlation between chronic sleep deprivation and increased rates of heart disease, which in turn puts one at risk for decreased brain health.

Quit Smoking, If You Smoke: Smoking increases your risk of developing cerebrovascular disease, a condition that causes your brain to not receive all of the blood necessary to operate properly.

WEIGHT LOSS INCREASES HUNGER

Keeping lost weight off is notoriously difficult.  A recent two-year experimental study helps to shed light on just why it's so hard: cutting calories and losing weight causes long-term increases in the hormone ghrelin that increases hunger.  To truly keep the pounds away, people have to deal with feelings of increased hunger for the rest of their lives.  

This study provided a structured highly supportive weight loss program for 35 Norwegians who were morbidly obese. At the outset, all participants underwent a three-week inpatient program in which all meals and snacks were provided.  The inpatient program also provided intensive instruction in how to achieve and maintain healthy behavioral change with nutrition education and psychological counseling.  Participants also participated in daily exercise routines. Over the course of the next two years, four more three-week inpatient sessions were completed.  Throughout the study, all participants were placed on a moderately calorie restricted diet, consuming about 500 calories per day less than otherwise needed to maintain one’s weight. The macronutrient breakdown of the diet was 50% carbohydrates, 30% fat and 20% protein.  Between inpatient stays, participants were advised to continue exercise and maintain a healthy diet similar to that provided at the center.  On average, the participants lost about 11 lbs. (~4% of bodyweight) within the first three weeks of the program, and an average of 24 lbs. (~9% of bodyweight) at the end of the two-year study.

At both the one- and two-year marks all the patients reported feeling increasing hunger following their weight loss.  Why did hunger levels increase? Results indicated that as weight went down, levels of the hormone that drives hunger, ghrelin went up.  Ghrelin levels went up with initial weight loss and these levels stayed up even as patients maintained weight.  

On top of the increase in hunger, people's bodies become more efficient in using energy after weight loss.  For example, on average, a person who has weighed 176 lbs. their whole adult life can maintain their weight consuming about 400 more calories daily than a person who has come down to 176 lbs. after previously weighing more.

What to do:  The take home message here is that weight loss maintenance requires deliberate lifelong dietary and lifestyle changes.  To minimize ghrelin increases during weight loss, it helps to lose weight gradually over time without drastic decreases in calories consumed.  To cope with increased hunger it helps to increase intake of low calorie fluids and non-starchy vegetables.  It also helps to adopt a healthy balanced diet that does not profoundly differ from one’s usual intake.  For example, diets that radically switch up your intake such as very low carbohydrate diets are unlikely to be maintained and are especially associated with weight regain. It is also recommended that in order to keep weight off, individuals need to engage in 60 minutes or more of physical activity most days.  Odds of maintaining activity are best when exercise is social and when one does activities one enjoys.  Recording intake and portions also is positively associated with weight loss maintenance.  The likelihood of morbidly obese individuals keeping weight off over the long term is much better with bariatric surgery, partially because the surgery significantly reduces hunger.  Even though it is hard to keep lost weight off, remember maintaining even modest weight loss of 5-10% of bodyweight can meaningfully improve your health.  And, regular activity and better food choices have many health benefits even if they do not result in weight loss.

Source

Coutinho SR, Rehfeld JF, Holst JJ et al.  Impact of weight loss achieved through a multidisciplinary intervention on appetite in patients with severe obesity. American Journal of Physiology Endocrinology and Metabolism, 2018; DOI: 10.1152/ajpendo.00322.2017

Information adapted from articles available at:

https://consumer.healthday.com/vitamins-and-nutrition-information-27/obesity-health-news-505/it-s-not-your-imagination-you-re-hungrier-after-losing-weight-731144.html

https://www.livescience.com/61703-weight-loss-hunger.html

www.sciencedaily.com/releases/2018/02/180201123318.htm