According to the National Institute on Aging we begin to loose muscle mass around age 40. At age 50 we begin to loose about 1/2 pound of muscle per year and gain one pound of fat. So by age 70 the average person has gained 20 lbs of fat and lost 10 lbs of muscle. “ No decline with age is as dramatic or potentially significant as the decline in lean body mass” researchers wrote in the Journal of Nutrition. You have probably heard of an elderly person who fell and broke their hip. The falling was most likely the result of weakness from decreased muscle mass. Then, that person continued to have a down hill course due to poor healing. All-cause mortality rate in older adults is increased 5- to 8-fold 3 months after hip fracture and persists with time, according to the results of a meta-analysis reported in the March 15 issue of the Annals of Internal Medicine.

Loss of muscle mass with age is called sarcopenia. In 2001 the Journal of the American Medical Association stated “Sarcopenia is the backdrop against which the drama of disease is played out: a body already depleted of protein because of aging is less able to with stand the protein catabolism that comes with acute illness or inadequate protein intake. Muscle is the major source of protein for functions such as antibody production, wound healing and white blood cell production during illness. If the body’s protein reserves are already depleted by sarcopenia, there is less to mobilize for illness.”

A well documented way to assess muscle mass, fat mass and water distribution in the body is called bioimpedance analysis or BIA. It involves passing a mild current from the hand to the foot traveling through the body compartments of muscle, fat, bone and water. Standing on the bathroom scale gives limited information. The BIA test can tell down to the tenth of a point if you are gaining or loosing fat or muscle. It is very sensitive to lifestyle and dietary changes. This can be performed in just a few minutes in the doctor’s office.

Some type of resistance or weight bearing exercise is necessary to stimulate muscle growth as well as adequate amounts of protein. Muscle growth can increase at any age although not as fast as younger people.

Please visit our therapeutic lifestyle program

The middle-age spread is commonly attributed to “slowed metabolism”, “hormonal changes” or “just getting old”. However, a recent study found that testosterone is the probable cause for the increase in abdominal fat in women during and after menopause. Deep abdominal fat surrounding the internal organs is recognized as an independent risk factor for heart disease and diabetes in women and men. The study evaluated 359 women between 42-60 years old in the Study of Women’s Health Across the Nation (SWAN). They looked at the relationship between blood testosterone levels and CT scans of visceral abdominal fat. The testosterone was a stronger predictor than estradiol for the fat. The reason for the elevated testosterone in the women was due to a rise in diet induced insulin levels. Eating a diet high in refined starches i.e. white breads, potatoes, cereal, rice and pastries causes blood sugar to rise, then the body produces insulin to lower the blood sugar. Insulin is a powerful hormone that can elevate testosterone in women. If the high starch diet continues over a period of years, insulin resistance can develop causing Type II diabetes.

Insulin resistance is the key feature in the Metabolic Syndrome estimated to affect 40% of the adult population in the U.S. It is defined by 3 out of 5 of the following: waist circumference greater than 35 inches in women and over 40 inches in men, blood sugar over 100 mg/dl, blood pressure greater than 130/85, HDL lower than 40 in men and lower than 50 in women and triglycerides over 150 in both sexes. Metabolic Syndrome is not a disease but a constellation of the above factors directly related to insulin resistance that can lead to diabetes heart disease and stroke and possibly cancer. Sedentary lifestyle and a diet high in refined starches and sugar (frequent celebration or holiday foods and deserts) are considered to be the prime causes with less than 30% due to genetics.

The good news is that the middle age spread and Metabolic Syndrome can be successfully decreased by dietary and lifestyle changes. After age 50 the average person will loose gain one pound of fat per year and loose ½ pound of muscle. By age 70 this adds up to 20 lbs fat gain and 10 lbs muscle loss.

Please visit our therapeutic lifestyle program

The average American who eats typical American food unknowingly consumes nearly two days worth of the recommended allowance of salt. For healthy adults, the American Heart Association recommends a daily salt intake of less than 2,300 milligrams (1 teaspoon). Most Americans consume about 3,500 to 4,000 milligrams of sodium a day.
The February 18th, 2010 issue of the New England Journal of Medicine reported that reducing dietary salt by 3 grams per day (1 tsp equals about 6 grams salt) from the national average of 10 grams is projected to reduce the annual number of new cases of heart disease by 60,000 to 120,000, stroke by 32,000 to 66,000, and myocardial infarction by 54,000 to 99,000 and to reduce the annual number of deaths from any cause by 44,000 to 92,000. The 3 gram reduction would also save 194,000 to 392,000 quality-adjusted life-years and $10 billion to $24 billion in health care costs annually.
For those with high blood pressure, the DASH diet (Dietary Approaches to Stop Hypertension) recommends 1500 mg salt per day, i.e. about two thirds teaspoon. After adjusting to lower amounts of salt the taste buds change and the previous amounts of salt will taste bad. It is easy to keep salt low by avoiding packaged snack foods, microwave dinners and eating restaurant food much less often. One entree at a common restaurant can have up to 6,000 mg salt, about 2 1/2 days worth. The ratio of potassium to sodium in the diet should be 5:1. This can be easily achieved by having 7-8 servings of fruits and vegetables per day and more beans and legumes. Look for labeled low sodium vegetable juice and canned goods. Remember, just a pinch of salt for good health.

Please visit our therapeutic lifestyle program

As reported last year in the Journal of Medicine & Science in Sports and Exercise, a moderate exercise program for 12 months reduces the levels of a inflammatory marker, the high sensitivity C-reactive protein or hsCRP, a well established risk factor for heart disease. It causes inflammation in the walls of arteries allowing cholesterol to build up and it can be ordered by any physician.

The study group consisted of sedentary, overweight, postmenopausal women 50-75 years of age. In the study, one group of women was assigned to an aerobic exercise plan of 60-75% of maximum heart rate for 45 minutes a day, 5 days a week. Another group was assigned to do one day a week of stretching. Blood tests were taken at the start, 3 months and 12 months. CRP decreased by 10% in the aerobic group but increased by 12% in the stretching group. Women whose body mass index was greater than 30 (considered obese) or whose waist was greater than 34.5 inches (over 33 inches considered obese) had the greatest decrease of CRP. The reductions in this study were achieved only through exercise and no dietary changes were involved.
The visceral abdominal fat cells that surround the internal organs are the primary source of the CRP as well as other inflammatory chemicals. During an infection the CRP will rise and then fall after the infection is resolved. So if there is no infection and CRP is elevated, then it is coming from the deep abdominal fat cells. Elevations in CRP are also associated with greater generalized body pains, and pre-diabetes. An hsCRP of less than 1g/l is considered low cardiovascular risk, 1-3 moderate risk and 3.1-10 high risk.

The good news is that the CRP if highly modifiable through lifestyle changes such as exercise and diet. Other studies have shown that CRP can be reduced even more through the combined lifestyle changes of exercise and the Mediterranean diet. Just because the study mentioned above focused on women doesn’t mean its findings aren’t relevant to men. Abdominal fat works the same way in women and men. If a man’s waist is greater than 40 inches, he is at major risk for heart disease and diabetes and most likely will have an elevated CRP. Lifestyle changes appear to work equally well in men and women.

Please visit our therapeutic lifestyles program

By Hunter Yost M.D.

Previous medical studies showed that lifestyle and dietary changes could provide long lasting protection against Type II or Adult Onset Diabetes but doctors weren’t sure for how long. Now a new just published in the journal Lancet, the longest follow up of patients from the Diabetes Prevention Program Research Group provides the answer. This study followed 3,234 non-diabetic patients with elevated fasting glucose and impaired glucose tolerance. The rate of new diabetes fell by 58% with intensive lifestyle intervention and by only 31% in those patients taking metformin (a common drug for diabetes) compared to placebo over 2.8 years. Over the next 5.7 years the original lifestyle intervention group maintained their low diabetes onset rate. When researchers combines the two time periods to cover 10 years, the rate of new diabetes fell by 34% in the lifestyle intervention group and by 18% in the metformin group. The authors concluded, “a carefully followed diet-exercise combination seemed to be superior in preventing or delaying the development of diabetes compared to the effect of anti-hyperglycemic drugs (metformin)…”

For those who would prefer to rely on medicine such as metformin, Avandia or Actos to treat their diabetes there is bad news. In 2008 in the New England Journal of Medicine, a study of 10,000 people showed that people who took medicines only to lower their blood sugar had a higher risk of death. YES, A HIGHER RISK OF DEATH. Why, because the medicines don’t treat the underlying cause of the diabetes which in insulin resistance when the cells of the body don’t respond to the insulin signal to lower blood sugar. The drugs make the problem worse by elevating insulin levels.

Contrary to the television commercials saying, “when diet and exercise aren’t enough” medical studies now show diet and exercise are not only effective but long lasting for preventing diabetes. The low technology approaches of lifestyle changes are not advertised since there is no profit to be made. Yet the improved quality of life and prevention of the serious consequences of diabetes is priceless to those who want to take charge of their health. The Mediterranean diet is the one used in most of these studies ands is in fact the most widely studied diet in all of medical literature for heart disease, diabetes, high blood pressure and arthritis. It can also help to reverse the problem of insulin resistance.

Hunter Yost M.D. has a private practice in northwest Tucson. www.hunteryostmd.com

Please visit our therapeutic lifestyles program.

By Hunter Yost M.D.

According to the American Journal of Clinical Nutrition, non-alcoholic fatty liver disease (NAFLD) affects about 70 million adults in the U.S. or 30% of the adult population. About 20 % of these individuals have the more severe form called non-alcoholic steatohepatitis or NASH. NAFLD is emerging as a major cause of chronic liver disease and is associated with the increasing prevalence of type II diabetes and obesity. It is the most common reason for the need for a liver transplant.

NAFLD is the most frequent explanation for abnormal liver test results and accounts for elevation of liver enzymes in up to 90 % of cases. Specific patterns of liver enzymes can be markers of insulin resistance, the primary cause of type II or adult diabetes.

Fatty liver is strongly associated with the Metabolic Syndrome. This is a pre-diabetic condition defined by 3 out of 5 of the following: blood pressure greater than 130/85, blood sugar greater than 100 mg/dl, triglycerides greater than 150 mg/dl, waist circumference greater than 40 inches for men and 35 inches for women and HDL (good cholesterol) less than 50 for women and 40 for men. People with Metabolic Syndrome have five times greater risked for diabetes, two times greater risk for heart disease, and significantly greater risk for stroke and gout. 64 million Americans are estimated to have Metabolic Syndrome.

The good news is that recently many studies show that the Mediterranean Diet can improve and prevent this fatty liver condition. This is the most researched diet in all of medical literature for heart disease, diabetes, cancer and arthritis. It consists of legumes, fruits and vegetables, nuts and seeds, fish, poultry, lamb, whole grains and minimal dairy. This diet decreases inflammation in all tissues of the body including the liver and improves insulin sensitivity so that adult diabetes can also be reversed. The standard American diet consisting of packaged and processed foods, soda drinks, fast foods, snack foods, refined sugars, and white flour based products is the primary cause of fatty liver, insulin resistance and expanding waistlines.

These dietary and lifestyle changes are a good example of effective low technology, low cost approaches to complex medical problems and are well documented in the medical literature.

Hunter Yost M.D. is in private practice in northwest Tucson. www.hunteryosymd.com

<

Recent estimates from the Center for Disease Control say almost two thirds of the population of the U.S. is either overweight or obese. Multiple chronic health issues related to being overweight include diabetes, high blood pressure, heart disease, degenerative changes in back and knees, and cancer. People with weight issues often want quick solutions. Rapid weight loss claims like losing 40 pounds in four weeks ignore established medical research recommending a one-pound weight loss per week for women, and 1-2 pounds per week for men. With rapid weight loss, muscle mass (one of the most important biomarkers of aging) is also lost. Many highly advertised weight loss programs fail to offer a specific plan to maintain muscle mass while losing fat - in other words, how to maintain a healthy body composition. In studies, there is increasing focus on healthy body composition instead of just weight loss since it is well known that aging, sedentary lifestyle, weight gain, chronic disease, and poor nutrition can lead to unhealthy changes in body composition.

Body composition can be measured through a simple, non-invasive device called a bioimpedance analyzer. A mild current, which cannot be felt, is passed through electrodes attached to the foot and hand. The current passes through the different body compartments: intracellular water, extracellular water, fat mass, and free fat mass (everything other than fat). If the current passes slowly, there is more fat mass and extracellular water. If it passes through more quickly, there is more intracellular water and muscle tissue. The analyzer is also programmed to calculate the amount of stored energy in the cells and cell membranes, called phase angle and body capacitance. Not surprisingly, healthy people have more stored energy than unhealthy people. Bioimpedance correlates quite well with the DEXA scan, which is considered the gold standard for measuring fat, muscle, and bone mass, but uses radiation so it cannot be used for regular assessment of body composition.

Traditional markers of total body weight, body mass index (BMI), and waist circumference are helpful for baseline information but cannot tell whether a person is gaining or losing muscle mass, or shifting from unhealthy extracellular water to healthier intracellular water. By measuring these latter biomarkers, along with the phase angle marker, we can track nutritional and lifestyle changes, and minimize the otherwise inevitable consequences of aging and disease.

A new term called ‘sarcopenic obesity’ is appearing in the medical literature. Simply put, it means loss of muscle mass while fat mass increases. Reduction in muscle mass can be caused by previous bouts of crash dieting, inadequate protein intake and inactivity. Sarcopenic obese people may even have a normal or low BMI measurement and look thin, but have a relatively high fat ratio – lending the term “skinny fat people”. Research from UCLA Center for Human Nutrition showing bioelectrical impedance measurements made of young women at increased risk of breast cancer demonstrated sarcopenic obesity in 38 out of 40 women. In these women, body fat is best reduced by encouraging heavy resistance exercise rather than simply restricting calories. Increasing their muscle mass will help increase their basal metabolic rates and burn more fat.

Incorporated into a comprehensive therapeutic lifestyle management program, bioimpedance analysis, performed every few weeks, can be a powerful tool to monitor body composition changes. It is also a great motivator as people see the results of the lifestyle and dietary changes they have made. With weight loss, slower is healthier, and energy usually improves quickly. Medical studies agree that maintaining muscle mass and minimizing fat mass is one of the best indicators of healthy aging.

Tucson, Arizona

Please visit our website

According to recent reports, there are definite signs of an economic recovery starting as soon as this summer. This is hopeful news for both your wallet and your waistline. Looking at this economic downturn from the perspective of diet and nutrition and the effect on general public health, we see that it is much different from the downturn of the Great Depression. Back then most people could not afford high fat meats and dairy products and turned to less expensive homegrown vegetables and beans. The rates of heart disease dropped dramatically. Then, during the growing prosperity of the 1950’s, the rates of heart disease climbed back to their pre-depression levels.

How many people today are turning to homegrown vegetables to cope with the current downturn? Hardly anyone I know. Why, because coinciding with the post-war economic boom was the rise of the fast food industry and the introduction of convenience foods (remember Swanson’s TV dinners) that did not exist in the 1930’s, providing inexpensive, high fat, high salt and sugar, low nutrition foods. In fact, the fast food industry is doing quite well right now with McDonald’s Corp. announced a first-quarter profit of $980 million, up 4% from last year and Burger King 1st quarter profits up 1.6% over last year. So this time instead of a decrease in heart disease and related problems there may be an increase. People’s waistlines are expanding as their wallets have been shrinking.

Our relatives of not so long ago had it right. They switched by necessity to healthier foods. Fresh produce, beans and legumes and poultry are relatively inexpensive today. Spending about one hour a week making a bean and vegetable soup can provide leftovers to last the rest of the week for a lot less money than eating out. Our parents, grandparents and great-grandparents also walked a lot more by necessity in those days than we do now. Unless we learn these important lessons from them, we may emerge from this recession much less healthy than they did when economic times were even worse.

Tucson, Arizona

Please visit our website

The causes of low energy can fill a medical textbook. Almost every chronic illness is associated with low energy. There are some easily fixable causes such as anemia and low thyroid. Severe fatigue not related to a diagnosable illness may be an illness in itself called Chronic Fatigue Syndrome in the U.S. or Myalgic Encephalomylitis in England, Canada and Australia. There may be deficiencies of vitamins, minerals and amino acids which can be assessed through blood and urine tests. Correcting these deficiences can improve energy for many people. There may be impairments of the immune system from viruses, bacteria or toxic metals or chemicals which can be evaluated and treated. The course of recovery is highly individual and is based on many environmental and genetic factors. The CDC has recently established the validity of Chronic Fatigue as a specific illness through extensive genetic studies.

Functional Medicine is a branch of medical science based on a biological systems approach to healthcare especially chronic complex illness. There are special functional medicine tests which evaluate how the body works as opposed to just what is grossly wrong. The Functional Medicine web or matrix includes gastrointestional and liver functioning, mediators of inflammation and the immune system, insulin and glucose regulation, cellular and mitochondrial functioning including oxidative stress, hormones, structural issues, the nervous system and neurodegenerative disorders and emotional health. All areas need to be addressed in conditions like fibromyalgia and chronic wideapread pain.