Maintaining the Mature Body

Maintaining the Mature Body rnPart 1: The Curse of the Paunch As Baby Boomers (born 1946 – 64), who grew up in the sixties, many of us are now entering our sixties and facing the unique challenges of inhabiting a mature body. What we discover is that the lifestyle choices that served us well for the last thirty or forty years, may no longer be appropriate. For example, our food choices have a much bigger impact on how we feel as we mature. And if we continue to eat as we always have despite a decrease in physical activity, we put on weight. Healthy aging is such an important topic that I will approach it over the course of the next several newsletters. The basic idea is that we enter this life with a certain genetic endowment – our physiologic reserve. Mother Nature in her generosity gives us more than we need. For example, we’re born with two kidneys but only need a quarter kidney to live. However, with a quarter kidney you can’t drink beer and eat pretzels. As we mature we use up our physiologic reserve. Like Michelin tires which are good for 40,000 miles – we can use our miles up quickly or spread them out. To put this another way, it is as though we begin our life on the Champs Elysees, a broad boulevard, and wherever we wander we’re still on it. But as we mature the road narrows to a 4-lane highway, then a 2-lane highway, and if we live long enough we’ll find ourselves on a little goat lane winding up a narrow ridge-line with a steep precipice on either side. The only thing that keeps us from falling off is our ability to stay in balance and not drift too far to one side or the other. It is a matter of skill, a matter of good taste. One of the early tell-tale signs that we are veering off course is the abdominal paunch that seems almost standard equipment these days. The paunch is much more than a cosmetic issue. What’s of concern is not the fat under the skin that hangs over the waist-belt, but the fat around the intestines and internal organs – what is known as visceral fat. In medical school I was sparred the unpleasantry of visceral fat, because our cadaver specimen was blessedly thin as a rail. My less fortunate colleagues had to scoop out copious amounts of glistening yellow fat, literally by the bucketful, before they could identify the anatomical structures of interest. The problem with visceral fat is that it begins to act like an endocrine gland – similar to the thyroid, adrenals, and gonads – and secretes a hormonal chemical messenger that promotes two deleterious effects: it increases insulin resistance and increases inflammation. In this newsletter we will focus on the insulin resistance problem and will take up the important topic of inflammation in the next issue. Insulin is the signaling molecule that controls how our body utilizes glucose. Since this is our the primary energy source, this signaling system is of fundamental importance. Insulin lowers blood glucose levels by promoting the uptake of glucose by muscle cells and other tissues. Insulin resistance, on the other hand, impairs the absorption of glucose at the cell membrane which cause blood glucose levels to rise. The elevated glucose levels initiates a vicious feed-forward cycle that stimulates the pancreas to increase insulin secretion above normal levels in an attempt to lower blood glucose. Higher insulin levels in turn promotes the storage of more visceral fat which feeds the paunch. Eventually, the pancreas gets exhausted and can’t keep up, at which point one slips into Type 2 Diabetes with its attendant risks of heart attacks, strokes, retinal problems, amputations and all the rest. Diabetes is an ancient disorder whose appellation derives from a Greek word meaning to “pass through” or “siphon” which refers to the symptom of increased urination. In the 17th century "mellitus" was added, from the Latin meaning “honey” a reference to the sweet tasting urine (yes, the doctor tasted the urine). What’s new is that Type 2 Diabetes is rapidly approaching epidemic proportions and may well become the greatest public health challenge of our century. Type 2 Diabetes was previously called Adult Onset Diabetes because it was almost exclusively a disease of people over fifty. However, in recent years it has been reaching down to afflict adolescents at an alarming rate. The causes for the changing epidemiology of diabetes is manifold. Often sited is the lack of exercise compounded by increased junk food consumption and super sized food portions. But one factor often overlooked is the significantly increasing levels of stress that cause adolescents and their elders to retreat into mindless addictions and overeating. At a biochemical and cellular level, elevated blood glucose sticks to proteins in a process known as glycosylation. Glycosylation is what forms the crust on bread when starches (sugars) are heated with protein in the oven. Needless to say crusty proteins don’t work very well and stymie cell-to-cell communications which ultimately leads to all the organ-level dysfunction. Fortunately, there is a very powerful way to reset insulin signaling and reverse all of these ill effects. There is a growing body of research on the extraordinary beneficial effects of caloric reduction and intermittent fasting. Roughly, a forty percent reduction in calories yields a forty percent prolongation in lifespan with markedly less disease. This has been true of every animal model studied from yeast to fruit flies to primates and is now being studied in human volunteers. It turns out that animals who are fed on alternate days (intermittent fasting) enjoy nearly the same benefits. There are no drugs that can come close to delivering these kinds of results. While few of us would be willing to live like this, might we enjoy some of the benefits of fasting once or twice a year, or once a quarter, or perhaps every Friday? Personally, I am exploring forgoing break-fast and extending the daily fast to lunchtime with a second smaller, light meal at dinner. I suspect this daily micro-fasting supplemented with a multi-day fast several times a year may have a more subtle but beneficial salutary effect. After all our Paleolithic genome was built to live from feast to famine, not feast to feast. The idea of starting the day with a hearty breakfast is just an idea and quite possibly an over-rated one. The bottom line is: the lean live longer! In general I have found over the years that the most effective way for people to change their habits is with little baby-steps. Although small, the right baby-step at the right time can be extremely powerful. So, here are some practical baby-steps you can begin doing to reverse the curse of the paunch. • Begin lightening your breakfast to a bowl of nutritious whole-grain cereal with a piece of fresh fruit. • At the same time increase your lunch portion modestly and transition towards eating a lighter dinner with more greens and less rich meats. • The habit of eating out for lunch is suboptimal. You’ll save money, as well as eat better if you get into the habit of packing a wholesome lunch of tasty leftovers. • Learn to enjoy the vitality and clarity that comes with being hungry and lean. • If you are not already exercising every day, develop an interesting, engaging way to work-up a sweat. Start slowly and work your way into it with intelligent baby-steps. • Develop your core strength, which is the basis of the Breathworks™ method and include modified sit-ups and crunches. • Consider the 10-day detox diet we offer which includes a high-tech 3 day supported fast to kick-start the process. I recommend this program be done twice a year for general health maintenance. • And remember whatever you pay attention to is enhanced. I was going to say “grows” but in the case of your paunch it will actually shrink.