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Little-known pearls for a healthier life and weight: Q&A; with Dr. Misra

Health Tips brought to you by U.S. HealthWorks Medical Group. Our experienced medical experts provide information here that we hope will broaden your healthcare knowledge.

Today we talk about weight loss and obesity in more detail with Dr. Anuruddh Misra, medical director for U.S. HealthWorks in South San Francisco. Dr. Misra is also double Board Certified in Sports Medicine and Internal Medicine.

Q: Weight loss-related searches rank among the highest of all Internet searches. Can you help provide some direction for our readers who want to be successful in their weight-loss goals?

A: I believe the first order of business is to set appropriate expectations. While there is always room to improve, I occasionally come upon people who are already at an appropriate weight for their height, body type and other considerations (for example, compare someone native to American Samoa versus Japan). There is an appropriate physiological weight range each person should be comfortable with, factoring in genetics, environment and concurrent medical issues, if any are present. At times our ideal thoughts on what our body weight should be does not comport with these factors. This is important to highlight, as having unrealistic expectations can (and often does) lead to unhealthy dietary practices. This is where education from a health care professional adept in this area is extremely important.

More often than not, I see the opposite problem – people are heavier than they should be – and cannot understand what more they can do about it to improve when they absolutely need to make changes. For general recommendations on diet and exercise, I would refer people back to my original blog on obesity, Intermittent Fasting and the findings of the “Blue Zones.”

Q: Given your expertise in this challenging arena of weight management, can you clarify any misconceptions and share any “insider tips” or “best-kept secrets”?

A: When I was in my Sports Medicine fellowship, my mentor, Dr. James Andrews, had recently published a book called Any Given Monday. In it, chapter 33 of this book was titled “Debunking a few myths.” I found this section of his book particularly enlightening as some ideas I had about Sports Medicine were incorrect, and he used many people’s common misconceptions as a good vantage point from which to teach. Keeping that theme in mind, I would like to bring attention to three misconceptions I had before my fellowship education to, hopefully, shed some light to best answer your question.

  1. Wheat is a good and healthy thing to eat
  2. Both weight lifting and cardio exercises are equally important to wellness and weight loss
  3. Type 2 Diabetes is irreversible

Myth No. 1: Wheat is a good healthy thing to eat.

Unfortunately, it turns out wheat and wheat products are one of the most caustic and damaging things to health one can cumulatively consume. Admittedly, this was a major blind spot for me before, but after further study, I understand this much better.

While I was always suspicious of wheat for various reasons, it wasn’t until my fellow Internal Medicine colleague, Dr. William Davis, published his book “Wheat Belly” when my concerns received outside confirmation. Now a Cardiologist, Dr. Davis published this excellent review on the demerits of wheat. While his findings are extensive, here are a few of the take home points I found to be the most useful:

  • Wheat has a high glycemic index, resulting in insulin spikes when consumed. This physiologically puts the body into a sort of “turn excess calories into fat stores mode,” concurrently inhibiting the mobilization of adipose (fat) tissue stores for energy, directly resulting in weight gain; two incorrect directions of energy flow for one seeking to achieve fat loss.
  • Phytates (a compound found in wheat) adversely affect the gastrointestinal track, resulting in an impairment of absorbing essential minerals and elements from food, chiefly zinc and iron.
  • Gliadin (the peptide in wheat) is directly responsible for numerous other systemic dysfunctions ranging from allergic reactions to cognitive decline (“brain fog,” potentially early onset Alzheimer’s) and even outright psychiatric impairment. Improvement in these conditions has been observed when wheat consumption ceased.

This graph explains the long-term ill effects of exposure to repeated insulin spikes. It is important to keep in mind that insulin also makes us hungry. This is why my mentor and colleague from UCSF, Dr. Robert Lustig – a Pediatric Endocrinologist – stated that refined sugar (and products along these lines, such as high fructose corn syrup) is a “poison” when I rotated with him during my Internal Medicine residency. While it may be hyperbolic to use the term “poison,” I now better understand his position. Perhaps a better way to think about this is what I once learned in medical school during Forensic Medicine: “There is a no such thing as a poison – it all depends on the dose.” The take home point is that insulin spikes cause a vicious cycle of storing excess glucose as fat, and while doing so, stimulate us to eat more, which is why high glycemic index foods such as wheat are so problematic. Sadly, insulin makes fat people fatter.

Our physiology was not designed to consume much sugar except for when found in fruits from nature. Even in such forms of consumption, the sugar is buffered by the fiber of whatever fruit it is coming from, resulting in only a modest insulin spike. In other words, this is not how we as a species started our mornings at the point of our earliest existence:

Given how easily accessible sugar is and how freely consumed it is now, our pancreas cannot endure prolonged high glycemic hits, such as result from sugar consumption over the years and decades. The result of this is an effective carbohydrate intolerance/insulin resistance, which leads to metabolic syndrome and Type 2 Diabetes Mellitus. Wheat products worsen this problem for the same reason (insulin spikes). Here are some simple examples of just how high the sugar spike is of two slices of whole wheat bread – again – often believed to be one of the healthiest things you could eat:

This is at least in part why a fellowship colleague of mine from EXOS, Danielle Lafata, Board Certified in Sports Dietetics and Sports Nutritionist for the San Francisco Giants, stated, “ The whiter your bread, the faster you’re dead.”

Sadly, whole wheat bread may only be a marginal improvement on this front. Alternatively, some benefits of a low glycemic index diet are listed below (this is not a complete list):

  • Decreased blood glucose levels
  • Decreased Type 2 Diabetes risk
  • Decreased vascular disease/heart disease risk
  • Decreased cancer risk (specifically: colon, breast and prostate by reducing IGF-1 levels)
  • Decreased age-related macular degeneration
  • Decreased weight

While some critics have referenced Wheat Belly as “fear mongering,” I would tend to disagree. Much of the data is not even Dr. Davis’, is sound in its foundation, decades in its collection and unfortunately not as widely known as it ought to be. Dr. Lustig has also been criticized for some of his positions, however he has good relevant points (debatable as they may be) to make when it comes to the obesity discussion.

Nothing happens suddenly with wheat consumption; nonetheless it is unhealthy to eat on a daily basis for long periods of time. It is so easy to consume wheat as it is present in an extremely high percentage of processed foods ranging from soup to candy, so we often eat it without realizing it. Making this paradigm shift in our thinking as it relates to wheat is a wide valley to bridge for many, in particularly for those who eat wheat as a centerpiece of their diet (as I used to), be it processed or otherwise. For me the most unsettling aspect of this data is we have been conditioned to consider wheat “healthy” for a long time, when in fact it is one of the unhealthiest things to eat in a cumulative sense.

Myth No. 2: Both weight lifting and cardio exercises are equivalent as it relates to wellness and weight loss

I believe even more important than understanding a reasonable individual weight range, people need to grasp the idea and importance of body composition. If a person lost ten pounds of fat but gained seven pounds of muscle, they may be upset to have only lost three pounds on balance. However physiologically, their metabolic profile would be tremendously improved. Measuring body composition usually requires an objective independent examiner with calipers, specialized equipment or access to a pool for hydrostatic body fat testing.

I would make a special point that while doing cardio (no less than 150 minutes/week for adults and 250 minutes/week for children) is essential, resistance training (weight training) is even more important. All weight training potentiates any cardio done, but the opposite does not hold true. Further, calories continue to be burned for upwards of approximately 14 hours after completion of a weight lifting session, which helps tremendously with both fat weight reduction and enhancing overall body composition scores.

The best case I have ever seen made on why it is essential to longevity to do resistance training (weight lifting) is summarized in this TED video. This video also touches on some of the physiologic processes that have resulted in the obesity epidemic. Lastly, weight training directly results in an increase in testosterone (free and total) as well as the “good cholesterol” known as HDL, each of which directly correlates to longevity in males, and this is far from an exhaustive list of the benefits of resistance training.

Myth No. 3: Type 2 Diabetes is irreversible:

This was perhaps one of the most striking things for me to learn and internalize after being taught for years that certain disorders are permanent, such as Type 2 Diabetes, dyslipidemia and hypertension. This is not true in all cases and quite likely not true in the majority of cases. To avoid sweeping statements, I will state that more cases of Type 2 Diabetes are reversible than previously thought. The same holds true for hypertension and other disorders when directly correlated to obesity.

My attention was first drawn to this when doing my Internal Medicine internship in Ann Arbor, Michigan. We often saw patients who had lost remarkable percentages of their body weight (more than 100 pounds) as we were located near a bariatric (weight loss) center. For those who succeeded in keeping the weight off, seeing Type 2 Diabetes, hypertension and dyslipidemia melt away was not at all uncommon. To further understand the effects of dietary changes, I highly recommend this TED video from Dr. Sarah Hallberg, who is a Diplomate of the American Board of Obesity Medicine and exercise physiologist.

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