Weight loss: What science says really works

Carole has been trying to lose weight for the past two years. She has tried weight watchers,  all number of different supplements but without any significant success. She has a very stressful family and work life leaving little time for exercise and has problems sleeping.

In 2014, 20.2% of Canadians aged 18 and older, roughly 5.3 million adults, were classified obese. (1) In 2013, it was estimated that Canadians spend nearly 7 billion dollars on weight loss products and programs. (2) There is much hype what works for weight loss but what does the current scientific research say.

What is best Diet for weight loss?

In a scientific paper recently published in the Lancet looking at the effectiveness of different diets for long-term weight loss, the researchers concluded that when compared with diets, the evidence does not support low-fat diets over other diets for long-term weight loss. (3) Other findings included:

• Low-carbohydrate diets led to significantly greater weight loss than did low-fat interventions.
• Low-fat diets did not result in differences in weight change compared with other higher-fat diets.
• Higher-fat weight loss diets led to significantly greater weight loss than low-fat interventions.

These findings go some way to dispelling the idea that low-fat diets are an effective intervention for long-term weight loss. On the contrary, it appears that a high fat, low carb is a better approach based on current evidence. This conclusion is backed up by findings from a study looking at the effect of a Mediterranean, high-fat, low carbohydrate diet, which found it had a significant impact on weight loss. (4)

What about exercise?

There is a commonly held belief that you need to do exercise to lose weight but is this true. When looking at the scientific data increasing exercise without any other changes has a modest effect on weight. (5) However, moderate exercise combined with other lifestyle interventions clearly had a significant influence on weight. (6)

Does sleep affect weight?

There is robust scientific research to show that poor sleep has a negative effect on overall health as well as weight. (7) A review paper found that reduced sleep duration is a causal factor of weight gain. (8)

What about stress?

While stress has a negative impact on health, there is only weak evidence that it causes weight gain. (9)

In conclusion

Lifestyle factors such as poor diet, sleep and lack of exercise can cause weight gain. When considering a weight loss program, the evidence points to one that includes a Mediterranean high-fat, low carb style diet, moderate exercise, and adequate sleep. While there is only weak evidence that stress alone causes weight gain it would be foolish to ignore because of the negative effects stress has on health. (10)

Disclaimer

This article in not intended to provide medical advice, diagnosis or treatment.

You are what you eat: Processed food additives linked to obesity, gut inflammation and food addictions

Processed food can remain longer on shop shelves, but what does that spell for our digestion? In a new research paper published in the journal Nature, scientists from Georgia State University examined how food additive emulsifiers affect the digestive health of mice.

Emulsifiers are added to most processed foods to prolong shelf life and enhance texture. The research team fed mice two of the most common emulsifiers on the market — polysorbate 80 and carboxymethylcellulose. They observed that the emulsifiers altered the mice’s gut microbiota or friendly bacteria found in the intestinal tract. Not only did this increase the risk of developing obesity, but also inflammatory bowel disease. It’s no coincidence both these conditions have been increasing since the 1950s.

"The dramatic rise in these diseases has occurred despite consistent human genetics, suggesting a pivotal role for an environmental factor," the study’s co-author Benoit Chassaing, a researcher from GSU’s Institute for Biomedical Sciences, said in a press release. "Food interacts intimately with the microbiota, so we considered what modern additions to the food supply might make gut bacteria more pro-inflammatory."

Emulsifiers help to hold food together. Mayonnaise without emulsifiers, for example, will separate from an oily top layer to a thicker white layer that rests on the bottom of the jar. Once the emulsifiers were ingested by the mice, their blood-glucose levels went awry, inflamed their intestinal mucus layer, which left them with weight gain, specifically in the abdomen. The bacterial change triggered chronic colitis and metabolic syndrome, which includes obesity, hyperglycaemia, and insulin resistance.

You are what you eat

Ultimately, you are what you eat. If your diet is smeared with margarine, mayonnaise, creamy sauces, candy, ice cream, and most other packaged and processed baked goods, you and your gut may be at risk.

"We do not disagree with the commonly held theory that over-eating is a primary cause of obesity and metabolic syndrome," the study’s coauthor Andrew T. Gewirtz, a researcher from GSU’s Institute for Biomedical Sciences, said in a press release. "Rather, our findings strengthen the concept intimated by earlier work that low-grade inflammation produced from a modified microbiota can be an underlying cause of excess eating."

Food addiction and overeating

What’s worse are the new results from research out of the University of Michigan, which found processed foods are the most likely to trigger a food addiction and overeating. The brain responds to processed food much like it reacts to street drugs. The very dense high-calorie processed foods do contribute an abundant amount of energy, which is why the body craves them. However, there’s a point when it becomes too much, and now it even changes the way the gut response to food.

Disclaimer

This article in not intended to provide medical advice, diagnosis or treatment.

Why am I still suffering after my road traffic injury? Despite months of treatment.

According to a report produced by Transport Canada, in 2012, 122,000 people suffered a personal injury resulting from a Road Traffic Accident (RTA), and 10,000 people suffered serious injury. A common injury from RTA is whiplash.

A recent review of current treatments of whiplash (WAD) found that many were ineffective. Below are a number of quotes from the paper which highlight its findings:

"Exercise and mobilization programs for acute and chronic WAD had the strongest supporting evidence, although many questions remain regarding the relative effectiveness of various protocols."

"For the treatment of acute WAD, there was strong evidence to suggest that not only is immobilization with a soft collar ineffective, but it may actually impede recovery."

"While there was also evidence supporting the use of pulsed electromagnetic field therapy and methylprednisolone infusion, the evidence was insufficient to establish the effectiveness of either of these treatments."

"Although some evidence was identified to support the use of interdisciplinary interventions and chiropractic manipulation, the evidence was not strong for any of the evaluated treatments."

"Sterile water injections have been demonstrated to be superior to saline injections; however, it is not clear whether this treatment is actually beneficial."

"There is contradictory evidence regarding the effectiveness of botulinum toxin injections, and cervical discectomy and fusion."

Why are current treatments so ineffective?

Current treatment of whiplash has a heavy bias towards physical therapy. While there is no doubt that whiplash does present with physical symptoms I propose that this approach fails to take account of possible underlying problems that may be holding back healing. With this in mind, when considering a treatment plan for somebody with an injury it is important to take account of:

1. Any physical injuries that were the result of the RTA e.g. fractures, disc herniations or prolapses, ligament or tendon tears.
2. Any pre-existing conditions or injuries that may affect healing.
3. Any conditions that may have been triggered by the RTA that may effect healing.
4. Status of lifestyle factors leading up to and after RTA including sleep patterns, relaxation practices, exercise and movement activities, quality of diet, stress and support system.

In my opinion, the reason why current physical treatments appear to be so ineffective is that they fail is that neglect to pay much attention to 3 and 4.

Lifestyle factors

Scientific and clinical experience has taught me that lifestyle factors are an important determinant of overall health. These factors which I like to call the pillar of health include:

• Sleep
• Exercise
• Diet
• Stress
• Social Support

Ensuring that these factors are as balanced as possible is vital if the body is going to heal.

Triggered conditions

An RTA may trigger physiological changes to your digestive and immune system that may hinder recovery.

• Concussion has been shown to cause reduced intestinal permeability (IP) or leaky gut. IP is associated with the development of food sensitivities, autoimmune diseases, and inflammation
• An RTA is a stressful event. Stress has also been linked to decreased intestinal permeability, reduced gut immunity, decreased stomach acid and reduced gut motility, all causing poor digestive function and inflammation.

An efficiently working digestive system is vital to good health and an effective immune system for healing.

In conclusion

If you are struggling with injuries from an RTA that are not responding to physical treatment you are not alone. Considering a Functional Medicine approach to your symptoms, one that looks at underlying factors and conditions, might lead to a better outcome.

Disclaimer

This article in not intended to provide medical advice, diagnosis or treatment.

Nutritional supplements and your health

Nutritional supplements (NS) are a hot topic in the Canadian media at the moment. Both the FifthEstate and Marketplace aired programs looking at the effectiveness and quality of NS sold in Canada. After watching the information presented it would certainly make you question whether NS should be effective and safe part of improving maintaining your health.

Do NS help?

In clinical practice, it is important to look at what evidence there is to show that something works. This can come in two forms, scientific research, and clinical observation. When looking at the scientific data it is commonly agreed among researchers that the best source to derive any truly meaningful evidence that something works is from research papers that review and analysis the data from some studies. These are called systematic reviews with meta-analysis  (SRMA). When looking at the most recent SRMAs looking at Vitamin and mineral supplements, the conclusions are varied between NS may give benefit, no benefit or even harm to health. Table 1 below shows a summary of the latest SRMAs. I have used some NS throughout the vast majority of clinical practice, beginning in 1997. From my observations of my clients, which have come to me already taking NS I would have to agree with scientific data that results are mixed. When prescribing any NS are am a big believer in using some form of testing to determine whether to recommend a client takes something. When adopting this approach in the majority cases, I have seen both objective and subjective benefits.

The case for food and exercise

While I have seen some remarkable results from prescribing supplements, these benefits have been limited to resolving specific problems and not overall health. From my 18 years of clinical practice, the most effective therapeutic approach I have observed has been from diet and exercise modification. This observation is pretty much in line with the scientific data from the most recent SRMA’a on the effect of diet and exercise on overall health. Diet and lifestyle modifications may have benefits in the management of Alzheimer's, Chronic Disease, Diabetes, obesity, visceral fat and overall health. Table 2 below shows a summary of the latest SRMAs looking at the effect of diet and exercise on health. There seems to be a particularly heavy weight of evidence suggesting that consuming more fruits and vegetables and incorporating exercise can have benefits for overall health.

In conclusion

I see NS very much in the same light as drugs they are simple solutions used to try and solve complex problems. Humans are complex beings and as such you need complex solutions to prevent and resolve health issues. Real food provides that complex solution, and this is born out from my clinical observations and current scientific research. If you are searching for that magic pill you are probably going to be disappointed.

Table 1

Supplement	Conclusions
Multivitamin and minerals	There is no evidence to support the use of vitamin and antioxidant supplements for prevention of cardiovascular diseases.
	There is sufficient evidence to substantiate the role of dietary multivitamin/mineral supplements for the decreasing the risk of age-related cataracts.
	Unlike observational epidemiological studies, this meta-analysis of RCTs suggests that there is no clinical evidence to support the efficacy of vitamin and antioxidant supplements in the prevention of esophageal cancer.
B Vitamins	B vitamin supplementation, when used for primary or secondary prevention, is not associated with a reduction in MACE, total mortality, cardiac death, MI, or stroke.
	A meta-analysis of 10 RCTs showed a borderline significant increase in the frequency of overall cancer in the folic acid group compared to controls.
Vitamin D	Continuing widespread use of vitamin D for osteoporosis prevention in community-dwelling adults without specific risk factors for vitamin D deficiency seems to be inappropriate.
	The effect size for Vitamin D in depression demonstrated in this meta-analysis is comparable with the effect of anti-depressant medication, an accepted treatment for depression.
Calcium	Increasing calcium intake from dietary sources or by taking calcium supplements produces small non-progressive increases in BMD, which are unlikely to lead to a clinically significant reduction in risk of fracture.
	Calcium supplements with or without vitamin D modestly increase the risk of cardiovascular events, especially myocardial infarction, a finding obscured in the WHI CaD Study by the widespread use of personal calcium supplements. A reassessment of the role of calcium supplements in osteoporosis management is warranted.
Chromium	Data from RCTs show no effect of chromium on glucose or insulin concentrations in nondiabetic subjects. The data for persons with diabetes are inconclusive. RCTs in well-characterized, at-risk populations are necessary to determine the effects of chromium on glucose, insulin, and Hb A1c.
Zinc	Zinc supplementation has favorable effects on plasma lipid parameters. Zinc supplementation significantly reduced total cholesterol, LDL cholesterol, and triglycerides. Therefore,  it may have the potential to lessen the incidence of atherosclerosis-related morbidity and mortality.
Antioxidants	Treatment with beta carotene, vitamin A, and vitamin E may increase mortality.

 Table 2

Diet	Conclusion
Diet and Exercise	Moderate-quality evidence from the present network meta-analysis suggests that D + E can be highly recommended for long-term obesity management.
	Results suggest that an aerobic exercise program, without hypocaloric diet, can show beneficial effects to reduce visceral adipose tissue.
Mediterranian Diet	The Mediterranean diet was associated with better glycemic control and cardiovascular risk factors than control diets, including a lower fat diet, suggesting that it is suitable for the overall management of type 2 diabetes.
	The Mediterranean diet in children may prevent asthma or wheeze.
Fruits and Vegetables	Sub-types of vegetables, such as root vegetables or green leafy vegetables may be beneficial for the prevention of diabetes while total FVI may exert a weaker overall effect.
	Green leafy vegetables may help prevent bladder cancer.
	This meta-analysis showed several inverse associations between fruit and vegetable intake and prospective improvements in anthropometric parameters, and risk of adiposity.
	This critical review of the associations between the intake of vegetables and fruit and the risk of several chronic diseases shows that a high daily intake of these foods promotes health.
	The evidence reviewed provides additional support for increased consumption of a wide variety of vegetables, in particular, dark-green leafy, cruciferous, and deep yellow-orange ones, and a wide variety of fruits, in particular, citrus and deep yellow-orange ones. Continued attention to increasing fruit and vegetable consumption is a practical and important way to optimize nutrition to reduce disease risk and maximize good health.
Exercise	Decreased physical activity were particularly strong predictors of incident AD.

Artificial Sweeteners: Friend or Foe?

A common question my clients ask me is what is my view on artificial sweeteners (AS). Many of the clients I see choose AS as an alternative to natural ones because of perceived health benefits. But are AS right or wrong for your health.

What the research tells us

Recent reviews of studies spanning at least the past 40 years have concluded that AS are potentially helpful, harmful, or have as yet unclear effects on health.

Some observational type studies show AS may cause harm including; 

• Altered satiety
• Weight gain
• Fat gain 
• Metabolic syndrome
• Increased blood sugar/diabetes
• Cardiovascular disease
• Hypertension

Because AS do not show clear benefit, and there is data showing, they may cause harm one can conclude that one should only use AS occasionally.

Other studies show:

• AS may cause an increase in waist circumference caused by increased belly fat.
• AS may have an adverse impact on your microbiota.
• People with certain microbiota types; know as AS responders, may be at increased risk for an adverse reaction to AS.

Stevia

A popular alternative to AS is Stevia but just because it is natural does not mean it is harmless. We

do not have adequate long-term studies determining Stevia is safe or beneficial. Because of this it is best used in moderation.

We can conclude that artificial sweeteners and sweeteners, in general, should not be used every day.

You can decrease your sweetener consumption by slowly reducing your use. Over time, as your body adapts, you should require fewer sweeteners.

Disclaimer 

This article is not intended to provide medical advice, diagnosis or treatment.

How stress can affect your digestion

Prolonged stress can be toxic to your digestive health, which is true for many of my clients that come to my functional medicine practice.

Meet Helen

Helen 40 is suffering from digestive issues that started six months previously. Her symptoms include abdominal cramps, alternating constipation and diarrhea, bloating, gas and heartburn. She has a full-time job working for the federal government and is a mother of two young children. She describes her diet as poor because she has to rely on many processed products and to eat out. Lack of time also means she infrequently exercises, socialises rarely and has not played her piano in a year. Her husband is often away on business leaving Helen to manage the home. She usually thrives on stress but since her last child was born she feels less able to cope with her busy home and work life. She suspects that the increased stress may have triggered her symptoms but is not sure how.

Scientists have identified some ways in which stress affects digestion.

Stress has been shown to cause:

• Increased Intestinal Permeability or Leaky Gut, which would predispose her to develop food sensitivities.
• Reduced gut immunity and reduced stomach acid production, predisposing her to the possibility of infections.
• Reduced gut motility, predisposing her to bacterial overgrowth in the small intestines.

Food sensitivities, gut infections and bacterial excess are potential causes of Helen's symptoms, but the root cause of these is her chronic stress. Without addressing the root, treating the other issues may prove a futile exercise.

Establishing that stress is the root of Helens digestive issues is easy, trying to untangle her from its grasp is the tricky part. Many people feel trapped in their lives and making any changes can seem monumental.

Change must happen however to begin the process of healing which means slowly unpicking stress making behaviours and replacing them with stress reducing or managing behaviors. For Helen, initial changes could be walking, catching up with her friends and sitting down at her piano.

Finally

I hope you found these ideas useful. More importantly, I hope you do something with them.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment.

Insomnia, sleep duration, quality and your health

Jackie 34 has been a bad sleeper ever since she was a teenager. She finds it hard to go to sleep and frequently wakes around 4 am when she tosses and turns until she usually gets up around 6 o'clock.

Jackie is not alone. An estimated 40 percent of Canadians suffer from sleep related problems according to a study conducted by Université Laval researchers under the supervision of Dr. Charles M. Morin. (1)

She has some concerns about her sleep:

• How might her poor sleep be affecting her health?
• How much sleep should she be getting?
• Why does she sleep so poorly?

How might her poor sleep be affecting her health?

Research has shown that poor sleep can have a significant effect on our health. But poor sleep does mean not only too little but also too much as well as the quality of sleep.

Sleep and overall chance of disease or death

Too little and too much sleep increases the risk of the possibility of death and illness. (2)

Sleep and your digestion

Participation in shift work, especially rotating shift work, is associated with the development of Irritable Bowel Syndrome and abdominal pain that is independent of sleep quality. (3)

Sleep disruptions can negatively alter the microbiota of humans. (4)

Sleep and your heart

Both long and short sleep duration associated with high blood pressure (5) (6), and with an increased cardiovascular disease. (7) (8)

But remember it’s not just about the length or sleep. The quality is also meaningful. Consequently, it has been shown poor sleep quality worsens hypertension.(9)

Sleep, Diabetes, Metabolic Syndrome and Obesity

Short and long sleep associated with increased type 2 diabetes. (10) Short sleep spans link with obesity in children. (11)

Also, again it’s not just about the sleep duration, the quality is crucial here also. Studies have revealed that:

1.   Sleep disruption has an unfavorable bearing on metabolic health (12)

2.   Inadequate sleep quality may contribute to obesity. (13) 

3.   Reduced sleep quality was determined to be an independent risk factor for obesity – even after accounting for other factors, like exercise (14) 

4.   Sleep disruption is a risk determinant for metabolic syndrome. (15) 

Sleep and your brain

Here are a few interesting facts on how sleep affects brain function.

1.   Poor quality sleep is associated with worsening cognitive performance over time. (16)

2.   Poor sleep in children decrease psychological health and increase health complaints. (17)

3.   Sleep helps repair, rewire and purify toxins in the brain. (18)

4.   Improved sleep patterns help with ADHD. (19)

Sleep and your immune system

Sleep disorders increase the risk of autoimmune conditions.

• Patients with non-apnea sleep disorder were associated with a higher risk of developing autoimmune diseases. (20)
• People with Obstructive sleep apnea have a greater danger of developing certain autoimmune diseases. (21)

Too Little Sleep May Quadruple Your Risk for Colds. (22)

How much sleep should she be getting?

For optimum sleep, it’s important that you:

1.   Consistently sleep between 6 or 7 to 9 hours; sleeping more or less has been linked to ill health. (2)

2.   Sleep soundly.

3.   Sleep and wake at approximately the same time; ideally going to bed around 10.

If you do have a sleep problem here are some basic tips and strategies for optimum sleep you can try:

• Light will inhibit melatonin secretion. Dimming lights, using a blue light filter, and wearing amber glasses can all aid with melatonin production.
• Ensure you sleep in cool enviroment
• Noise – Quiet
• Non-stressful pre-bed activities
• Aim to be in bed by 10 or 11 and then sleep 7 to 9 hours, but recognize if you constantly can’t get 7 or need more than nine something might be off.

Why does she sleep so poorly?

If you find you consistently need more than 9 hours of sleep or can’t stay asleep for 7 hours you should investigate an underlying illness or imbalance including: 

1.   Inflammatory or digestive issues (23)

2.   Alzheimer's Disease (24)

3.   Adrenal dysfunction

4.   Hormonal Imbalance

5.   Blood sugar issues

Finally

I hope you found these ideas useful. More importantly, I hope you do something with them.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment.