Dr. Sekula on weight loss, fitness and nutrition

On March 10, 2010, the Medical Wellness Association sponsored a Medical Wellness and Nutrition forum as part of the IHRSA convention in San Diego. As an aside, Sunny San Diego? Are you kidding me? It was sunny, but, man, was it cold! The wind was blowing. Hard. Felt it to my bones. Probably not cold to someone from Minnesota, but to a Texas boy it was. And can you do something about the homeless people? The only place I’ve been where it was worse was downtown Baltimore.

So back to the forum. There were four speakers (including me), each presenting on a topic related to nutrition and wellness. I think the forum was well-received. I listened to all presentations and only one other excited me. Amy Blansit works with obese people in Missouri and she gets it. Her presentation was excellent and she’s doing a bang-up job. The other talks seemed rather fluffy.

In order to gain more attention, I badly titled my talk: “How to increase revenue with weight loss programs.” IHRSA is not the most scientifically rigorous organization. A more appropriate, but boring, title would have been: “Misapplication of the energy balance equation.” That was the focus of my talk, but no one would have attended. I spent nearly half of the two hours building this up and why weight loss programs fail (or, the misapplication idea).

For more on this, check out Dr. Eades’ blog, Protein Power, more specifically, this recent post. You can also read this post by Robert McLeod on energy balance, it’s at the bottom of the post.

The gist of the talk centered on the pervasive notion of eat less, exercise more. For overweight and obese, hyperinsulinemia equals metabolic domination, efficiency at fat storage and feeble efforts in fat mobilization. Simply eating less does not fix this and leads to failure.

Oh, and before you chime in with ASP, leptin and all the others, don’t bother. ASP is a toothpick to the bat of insulin. While the research on leptin and leptin resistance is fascinating, I have yet to work with someone where it was a problem. I know it’s there, somewhere, and I know it exists. Just haven’t run across it in my day-to-day business.

You can also view the presentation at slideshare.net.  Don’t know why, but the embed code has jacked up the first slide. It’s normal at slideshare. Below the presentation are links to a reference list and white paper.

Click here to download the references.

Click here to download the white paper. Note: I can’t find my white paper. It’s somewhere on my laptop. I’ll hunt it down and post the link in the next day or so. 

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Jeff Garlin, co-star and executive producer of Curb Your Enthusiasm, has written a memoir about his lifelong struggles with weight. In an interview for ABC news, Garlin talks about his addiction to food and his new diet. You can read the interview and watch a video here.

This is sad. Really sad. He said he’d eat and eat and eat and never feel full. Stand-bys included gourmet sandwiches, pop-tarts and Cap-n-Crunch cereal. In the video, he talks about donuts and milkshakes. Also, knowing that a single donut or any sugar-filled food would send him over the top, meant these foods were forbidden and that moderation was not possible.

He alluded to his lifelong struggle with weight. Although not prominent, I’m sure there were never-ending attempts to lose weight. Well-wishers like Larry David, his wife and others, I’m sure, encouraged him to lose weight. I’ve never met a person that was overweight who didn’t want to lose weight. Really, I’ve never known an overweight person that hasn’t tried every diet under the sun.

At age 37, he suffered a stroke. At his heaviest, he weighed 320 pounds. Through various changes he’s down to the upper 260’s. I’ll talk about those changes in a second. 

So what’s going on? What’s the problem? Why can’t Jeff Garlin, et al just buckle down and lose weight? The answer lies in the ubiquitous message of energy balance. Accordingly, you can eat what you want, just eat less and the weight will disappear. Not in Jeff Garlin’s case.

Despite the fact he’d eat a half-dozen donuts and a milkshake, he was never full. He talks about stopping at In-N-Out Burger on the way home from work to get two double cheeseburgers because dinner at home would not be enough. He also mentions the ability to eat an entire pizza and wash it down with five boxes of instant pudding, topped off with graham cracker crust. I wouldn’t be surprised if that didn’t fill him up, either. 

The problem with the energy balance equation is that it assumes we can simply restrict calories and lose weight. Completely ignoring the real issue, insulin, of which Mr. Garlin could not be a more perfect example

As Gary Taubes eloquently pointed out in Good Calories, Bad Calories, hyperinsulinemia  drives fat storage and dictates cellular starvation, regardless of food intake. This is spelled out specifically in Chapter 22, The Carbohydrate Hypothesis. More specifically, on page 399 (paperback), he discusses the role of lipoprotein lipase (LPL) and fat storage. As insulin levels rise, triglycerides are preferentially stored in adipose tissue.

During caloric restriction (as I’m sure Mr. Garlin tried, you know, eat less, exercise more?), weight loss becomes more difficult and even problematic. Fewer calories lead to decreased muscle mass and smaller organs (brain and kidneys, for example), in the face of hyperinsulinemia. It’s a feedback loop, driven by insulin, that works to maintain body fat levels, even in the face of decreased organ systems.

So Jeff Garlin likely went on a typical diet of eat less, without changing the types of food he ate. Since his insulin levels were still high, it only made him hungry. Probably hungry as hell. And he could only hold on for so long.

One thing those foods will do is elevate insulin. All that glucose has to go somewhere. I’m sure he Jeff wasn’t exercising. Even if he was, there’s no way in Hades he was depleting his glycogen stores, so that glucose went somewhere. It got converted to fat and stored.

All of this brings me back to his new approach. I wish him well, but I have my reservations. Here’s what he’s doing. He meditates daily, 5:30am. He cut out sugar, fast-food and binge-eating. He doesn’t eat salt, chicken, turkey, red meat or ham, although he does still eat fish. He eats fruit, vegetables and whole grains. “It’s all very boring,” he says. Giving up sugar was, “really, really hard.”

He’s done pretty well. Lost about 50 pounds. Gave up sugar, salt and most forms of protein and he meditates. I think he’s been successful so far because of sugar elimination. I have no idea how much sugar he was eating, but with milkshakes, pizza, cereal and donuts, it had to be a boatload. I’m guessing 400-500 grams, minimum.

The problem I see, however, is the whole grains and fruit. His insulin is down, which helps the cravings. For the long run, however, it’s not down enough. He’ll find caloric balance soon and will get stuck, probably several pounds away from his goal weight. Then what? Probably try to eat less, again.

What will be the culprit then?

*Photo courtesy of abcnews.com.

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Most people I work with are significantly overweight – average weight > 300 pounds. As you might expect, all have a cluster of metabolic disorders. Coincident with their condition,  they take a laundry list of prescription medications. In general the lists are nearly identical and include prescriptions for hypertension, diabetes, cholesterol and digestive disorders.

Given this, I assumed their laundry list was similar to that of the general public. So I went looking for the top 10 prescription drugs of 2008 to see if my thoughts would be confirmed.

Finding the Data.
I scoured the FDA website and could find nothing (for some reason, I thought the organization in charge of controlling this industry might track this stuff – go figure). I decided to contact them by phone and the person I spoke with (after about 3 minutes of menu clicks – seriously), directed me to drugtopics.com – here is their about page.

Table 1 shows information for 2008 (1), including the top 10 prescriptions, the number of prescriptions (millions) and retail sales (in billions) (2). Note: the list is for non-generic drugs only. Additionally, drugtopics.com separates their publications by top prescriptions and top selling. Table 1 is a combination of the two. The Sales column includes rank information.

 Table 1. Top 10 Prescribed Drugs in 2008.

Confirmation and Surprise.

So what was the confirmation? Cholesterol, hypertensive and digestive (GERD) disorder medications occupy spots #1, 2, 7 and 10 (italicized in table). They represent 110.2 million prescriptions and $15.3 billion in retail sales. It’s 40% of the top 10, 45% of all prescriptions and 49% of total retail sales. Lipitor by itself is 20% of all prescriptions and 19% of all retail sales for those in the top 10!

What surprised me? For starters, no diabetes drug in the top 10. Actos was the highest rated and it was 18th, with 12.5 million prescriptions. The $2.4 billion in sales would have been good enough for 10th on the sales list. This piqued my curiosity and led to another visit to drugtopics.com.

Thankfully they track prescriptions and sales of generic drugs too. Guess what was in the top 10? I’ll give you a hint. It starts with “M” and ends with “M.” This list too is dominated similarly and I’m working on a follow-up post.

My thoughts…

Insulin resistance is big business in this country, playing a small or large role in nearly all of these on the list. And the Standard American Diet (SAD) is being pushed down our throats by so many factions, I don’t even know which way is up sometimes.

With all the healthcare debate going on, it’s amazing to me those in charge can’t see what’s right under their noses. I’m blaming cognitive dissonance and the powerful sugar, corn and wheat lobbies.

My advice, trash the food guide pyramid. Ignore nearly all advice from registered dieticians and your doctor – they’re part of the cognitive dissonance crowd. Eat quality protein and healthy fats (including naturally saturated ones) at every meal, along with vegetables and exercise vigorously 2-3 days per week. That and keeping your stress levels down will go a long way to keep you from being on this list.

This post is part of the Kathleen Show, Prevention not Rx.

References (both are pdf documents).

1. 2008 Top 200 branded drugs by total prescriptions.

2. 2008 Top 200 branded drugs by retail dollars.

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Props to Heather Davis. She has lost 110 pounds. It’s a story many would like to live. She didn’t follow a gimmicky diet or or sign-up for a quick fix fad. She did it with a good plan, hard work and perseverance.

Here are ten tips she offered in a CNN story that you can use to help you on your journey.

I like all of these tips. I use variations of nearly all of these in my weight loss program. One that I haven’t used but will incorporate immediately, Tip #8, keep an item of your “big” clothes as motivation. That’s a great idea!

Congratulations Heather!

1. Never let anyone tell you “You can’t.” Yes, you can.
2. Get as much social support as possible. Going to the gym with others is fun and motivating.
3. You will not be the biggest person in the gym and everyone will not be staring at you.
4. Some thin people in the gym used to be really heavy and they will applaud you.
5. Lose weight for you. Not because someone else tells you to. Also, know when to stop losing.
6. If you lose your way (fall off your diet), get right back into the saddle and try again.
7. Keep a calendar. Mark off every day you exercise and eat right. You will see the days rack up, and it will make you proud.
8. When you do lose weight, save one item from your heaviest weight. Look at it when you feel discouraged and you’ll see how far you’ve come.
9. Don’t let friends or family derail you. If you don’t want to eat something, it is OK to politely decline, but don’t go crazy. You don’t want to be “that person” at the lunch table.
10. If you want cheesecake or a sweet treat — eat it in moderation. Don’t deprive yourself of anything or you will get discouraged.

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First, you need to get into my boot camp. Today is the last day of the first week, but you can still register – right up until next Friday!
Second, If you’re skeptical of the results you can get from a Boot Camp, read this article.here.

Finally, the best Boot Camps are fun, challenging, rewarding and most importantly, get results. Exactly what you get.

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The American College of Sports Medicine published it’s fitness trends report for 2008 in December of last year.

A pdf version of the article is here: http://www.informz.net/acsm/data/images/worldwidetrends.pdf

In surveying nearly 2,000 fitness professionals throughout the world and corroborating with internationally known fitness experts, a list of 20 fitness trends was identified. I’m giving you the top 10 and adding my comments to each.

Take a look and let me know what you think. Are your New Year’s Resolutions aligned with any of these trends? Are you a member of a health club or fitness center that offers services like these? Do you have access to these services?
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Number 1: Educated and Experienced Fitness Professionals
There is currently no regulation of Certifying agencies for fitness professionals. Anyone can offer a “Personal Trainer” cerfitication and not have standards to meet. However, more and more certifying organizations and schools are becoming accredited. This is great. Just as hiring a CPA gives confidence that certain levels of education have been obtained and demonstrated, so should it be with fitness professionals.

As a doctor, I continuously push for higher educational standards of personal trainers and you should too. After all, you literally put your life in their hands. And if a trainer you have chosen isn’t educated and trained regarding contraindications, you are taking a big risk.

Number 2: Children and Obesity
This is an important one. Reports have been saying for a while that this may be the first generation that doesn’t outlive their parents. And a big part of that is obesity and related lifestyle disorders. If we can keep physical education in the schools and take advantage of physically active based after school programs for our children, it will be a major step in the right direction.

Number 3: Personal Training
This will be a staple of the top 10 every year the survey is conducted. Learning to exercise properly, whether it be for health or sport, should be your number one priority. And a well-educated personal trainer is invaluable in that regard. Without proper instruction you are more likely to get injured and may never reach your goals.

Number 4: Strength Training
Personally, I’m glad this is in the top 10. The health benefits of strength training are simply too numerous and profound to ignore. You must incorporate strength training into your exercise routine.

Number 5: Core Training
At one time, people thought this was a fad. But it has certainly lasted long enough to be called a trend. Core training has been defined as training the muscles of the abdominals and lower back. Some include balance training too. Whatever the case, strength in the trunk of your body is needed for support. Strengthen your core and you’ll feel better.

Number 6: Special Fitness Programs for Older Adults
As you age, health becomes more important (it really should be important from day 1). And programs tailored to older individuals are more popular. Programs like these focus on increasing strength, flexibility and performing activities of daily living. As a side benefit, all of these things significantly improve your health too.

Number 7: Pilates
A form of core training, Pilates has been a staple of the fitness scene for years.

Number 8: Functional Fitness
This is a form of exercise that improves your ability to perform activities of daily living. A well-balanced program will improve overall strength, flexibility, balance and heart fitness. As you progress, you will feel more confident when performing regular tasks as your risk of injury and adverse events decreases.

Number 9: Swiss Ball
Most people refer to them as stability balls. These are the large balls most fitness centers now have. They can be used to perform an almost limitless number of exercises, focusing on training the abdominals, improving balance and overall stabilization. Core training incorporates the use of stability balls.

Number 10: Yoga
A form of mind-body exercise that focuses on flexibility, posture and meditation.

Additional thoughts by me…
I like the list and am considering posting 11-20. However, I think teasing out the differences in some of these is difficult. For example, Core Training, Functional Fitness, Pilates, Swiss Ball and Yoga aren’t all that different – at least not different enough to have their own categories.

There are a couple of things I would have liked to seen in the top 10:

1. Greater focus on dealing with chronic diseases and conditions that physical activity positvely effects. For example, there is no mention of type II diabetes, high blood pressure or heart disease. This might fall under the auspices of education, which is #1. In my personal opinion, fitness professionals could do themselves (and their industry by default) a lot of good by educating themselves in these areas, creating services to help more people and having a positive impact in the lives of people.
2. More focus on developing services to help businesses improve the health of their employees. All fitness centers and personal training studios have small businesses close to them. They should be developing programs to help these businesses reduce health-related costs. For example, we recently performed a healthy back seminar for two different companies with amazing results. Based on worker productivity, reduced sick time and improvement in back pain, the companies were able to realize savings of more than $40,000. That’s a lot of money. Click here to read our press release.

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January 07, 2008.

From a recent article posted in the San Jose Mercury News by Melinda Sacks…

I took the liberty of highlighting important benefits in each of the points. The benefits of weight training are numerous and this article does a good job of highlighting some of the more
important ones.

Even though this article is geared toward women, the same benefits listed apply to men. So you guys don’t get off that easy.

Researchers say that most women who exercise still spend the majority of their time doing cardio, often ignoring the benefits of weight lifting. But unless a doctor advises otherwise, weight lifting can provide enormous advantages for most women, according to studies from such institutions as the Mayo Clinic, Harvard and Stanford universities. As with any new physical activity, check with your doctor if you have any health issues.

Here are the top 10 reasons sports medicine doctors and fitness experts agree weight lifting is good for you:

1. By becoming physically stronger, you will make routine tasks easier and safer to perform, from carrying heavy groceries from the car to picking up the kids.
2. Weight lifting will help you lose body fat and gain lean muscle. As this happens, your body mass decreases, your resting metabolism increases, and your clothes will fit looser. For every additional pound of muscle you gain, you will burn 30 to 50 more calories a day. Weight lifting is often touted as a proven way to keep weight off as women age.
3. Women don’t need to worry about bulking up as they get stronger. Unlike men, women do not have enough testosterone to build bulky muscles. Men have 10 to 30 times more of the hormone than women.
4. The risk of osteoporosis goes down as you gain muscle strength. Weight training can increase spinal bone density significantly in just six months.
5. Risk of injury decreases when you are stronger. You will be less prone to everything from back pain to arthritis to depression.
6. It’s good for your heart. Lower blood pressure, improved cardiovascular health and higher levels of “good cholesterol” have been found to be the side benefits of regular strength training, according to numerous studies.
7. The risk for diabetes declines because weight training has been found to improve the way the body processes sugar.
8. You can start weight training at any age. Research has shown that even women in their 80s can still build muscle strength.
9. Weight lifting can improve mood and fight off anxiety and depression. One Harvard study found that after weight training for 10 weeks, those suffering from clinical symptoms of depression felt better than those who received only counseling.
10. For women in middle age, strength training can help prevent the predictable metabolic sluggishness that often occurs. Many say it is not dieting, but weight lifting that is the true secret to keeping off middle-age pounds.

 

I will comment on one thing. In the opening paragraph, the author suggests that a majority of women spend their time doing cardio. I believe this is true. In my humble opinion, walking on a treadmill for 30- to 60-minutes is like Chinese water torture. You’re better off cranking up the intensity and going for a shorter period of time.

And don’t get me started on the benefits of slow-cardio and fat burning.

It simply isn’t a good use of time in a world where we’re all busy.

Off the soapbox…

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On Friday I mentioned a new service debuting today. You can find more info on that and other services we offer guaranteed to help you achieve your weight loss goals.

• Looking for a trainer? You found one here. But what if you don’t live in or near Sugar Land. What if you are really serious about achieving your goals this year but are hesitant to just hire any old trainer? I don’t blame you! What if you’re nervous about joining a gym and just want to workout at home?
  The answer to all of those questions and more is my newest service, BSFC Remote. When you sign-up, I’ll design a workout program specific to you. It will be based on your current abilities and the goals you want to achieve. It will include a daily schedule for weight training, cardio and stretching. Every activity I give you will have illustrations showing you the exact beginning and ending position. Additionally, each activity will have a text description “talking” you through performing it. These two things ensure you will perform the exercises safely and properly – leading you right down the path of success. It’s a step-by-step guide to reaching your goals. As if that weren’t enough, you’ll have unlimited email support throughout your program. Have a question? No problem, shoot me an email and I’ll get back to you. I know it sounds good and you’re ready to go. That’s great, but you better sign-up today. I’m having a serious special on this program. A limited number of spots are available and when they are full, I’m raising the rates. So get yours today for an amazingly low price!

   

If you’re like most Americans, you want to get in shape this year. I can’t think of a better option than BSFC Remote (unless you want to train with me in person).

• Don’t forget, the day after tomorrow (Wednesday) is the free webinar on living, looking and feeling younger. I’ll be covering all the keys you need to unlock a more youthful body. But, you can’t get those keys without registering. Click here to learn how to live, look and feel younger.
  
• Don’t forget #2. Next Monday (January 14, 2008) is the first day of class for my 6-week Boot Camp. Imagine reaching all of your weight loss goals by the middle of February! You can do it with this Boot Camp. In six weeks you will do more for your health and body than you ever thought possible. You’ll burn fat, get stronger and leaner, get rid of those aches and
  pains, have more energy, and more. Like I said last week, if you live within 10 minutes of the SW Freeway and Beltway 8, you are making a mistake by not signing up. There is an AM session and a PM session, so I’ve got your morning and afternoon workout covered. We start January 14 and spots are limited (and filling up fast) so if you’re ready to change the way you feel and the way your body looks, sign-up today!

 

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That’s all for today. Make it a great day. I’ll see you soon. Until then, break a sweat today. It will do your body good. Brian

Sign up here to receive regular articles like this.

Links for you:
Live, Look and Feel Younger
6-week Boot Camp
BSFC Remote

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11 Steps guaranteed to get you there!

How do you feel right now?

• tired?
• soft and mushy?
• sluggish?
• bloated?
• unable to focus?
• no drive?
  

Why do you feel this way? Is it just the natural aging process? Should you live through your 50′s, 60′s, 70′s and beyond feeling tired, taking prescription medication and feeling this way?

Is it acceptable to forget where you put your keys? Is it acceptable that as you age, you get soft in the middle and gain weight? Is it acceptable that as you age you wake up for 2-3 hours every night, exhausted but unable to fall back asleep? Is it acceptable that you take prescription medication to feel better? To stay more focused? To increase your sexual desires and appetite?

These things aren’t acceptable to me. But how many people do you know live this way now? What about you? Do you live this way now? Is everyday like this? Is it acceptable to you?

I know it’s not acceptable to you and that’s why you are here!

You can learn all the secrets to maintaining youth and vitality in a FREE web-based seminar I’m holding on January 9, 2007, at noon CST. Yes, I said absolutely FREE. You’ll also get great stuff just for sigining up.

How do you sign up?

Simple. Just go to this website and enter your first and last name and email address. I’ll take care of the rest.

See you there.

Don’t Forget: Wednesday, January 9, 2008 at noon, CST.

Sign-up here: http://www.briansekula.com/antiaginghouston.htm.

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Here is the post I promised in the newsletter on increasing torso rotation.

In the article, I said the golf swing was complex and any program needed to take this into account. The stretches below do just that.

Each stretch should be performed in two different ways. The first is a more traditional method of stretching and will improve your static flexibility. The other will improve your dynamic flexibility.

For the more traditional method, perform each stretch for 3 sets of 15 seconds. That means to perform the stretch as stated in the text description and hold it for 15 seconds. Relax and then do it two more times.

For the dynamic method, move to the point of feeling the stretch as indicated in the text description and hold for only 2 seconds. Relax and perform again. Repeat this 9 more times for a total of 10 repetitions. Each time you perform the stretch, try to move a little farther. Do this for all of the stretches.

Perform the stretches daily. On one day, perform only the traditional stretches and on the next perform only the dynamic stretches. Go back and forth this way for an entire month and see what a difference this will make.

You’ll see results!

Okay, we’ve got four stretches here. One each for the hamstrings, back of your hips, front of your hips and your torso.

Unfortunately, you’re going to have to download the file.

I tried posting the pictures and text descriptions. I really did! I simply could not get them posted short of making a long list – it was too long.

So I created a pdf file that contains them all. Right-click and select save as to download this file.

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From the American Heart Association…

“Research shows that when properly supervised and prescribed in the light of a patient’s history and condition, whether they have cardiovascular disease or not, resistance training increases muscular strength, endurance, independence, and ability to perform a large range of activities. It reduces disability and enhances quality of life. Other benefits include increase in bone mineral density and lean body mass.”

In their recently updated public statement (a full pdf version can be found here) on weight lifitng and heart disease, the AHA has recommended doctors encourage their patients to participate in strength training exercise.

Anyone in the fitness industry worth their credentials on the wall could have told you this years ago. I don’t know how many older clients I’ve trained that walked at least twice as fast once their session was over compared to when it started – no comments about trying to get away from me as fast as possible either .

But it’s good to know that an organization the size of the AHA is getting serious about weight training for heart health. As we age, health becomes our main concern. And rightfully so. If we can’t live independently, the golden years are less enjoyable.

Resistance training increases our ability to live independently. We are stronger. Our joints are more mobile. And, importantly, our balance is better by default. So what other benefits could be more important? If you have some better (or if I’ve left something important out), please let me know.

If you’re not lifting weights, start a program now. It’s never too late. There are even fitness centers that cater to those 55 and older. Additionally, most clubs will offer a discount to senior citizens. If the one you’re looking into doesn’t, go somewhere else.

Until next time, lift weights today and break a sweat. It just might do you some good!

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