Battling the obesity epidemic (with dark chocolate)

Lindt 90% Cocoa Dark Chocolate

The Centers for Disease Control (CDC) tell us that we are suffering an obesity epidemic. “Obesity is common, serious, and deadly.” Forty percent of middle age adults are obese.  

While obesity may seem somewhat harmless, and is even normalized by Hollywood (Melissa McCarthy, “Mike and Molly”), obesity is anything but cuddly. “Obesity-related conditions include heart disease, stroke, type 2 diabetes and certain types of cancer, some of the leading causes of preventable death.”

Further, it is very expensive. The Boston Globe recently decried that Massachusetts health care spending spiked 4.8% last year, an unsustainable rate. So it should concern us to learn that the CDC has identified the significant costs of obesity: “The estimated annual medical cost of obesity in the U.S. was $147 billion… the medical costs for people who are obese were $1,429 higher than those of normal weight. “

It’s clear that if we can begin to reduce this plague of obesity, we would reap a number of benefits: longer life, better health, and reduced medical costs (both individually and socially).

But how to achieve that goal?

Again, the CDC: “The key to achieving and maintaining a healthy weight isn't short-term dietary changes; it's about a lifestyle that includes healthy eating and regular physical activity.”

We hear this more and more, from a variety of sources. Just get more exercise, bike, jog, or walk. And eat better.

Let’s focus on the latter point. A pair of recent studies reemphasize the importance of your microbiome, the trillions of bacteria resident in your gut.

In a study performed at the University Medical Center Groningen in the Netherlands, researchers tracked the blood chemistry and gut microbes of 893 people. What they found was surprising. The kinds of bacteria in your gut can affect your weight and heart health. Additionally, according to Dr. Tara Narula, on “CBS This Morning,” "the more diverse your bacteria were, the better your HDL and triglycerides.”

In separate findings, several studies in the United States point to a complex relationship between diet, gut microbes, and immune system response. Science News reported on May 30 ”A tantalizing line of evidence suggests that unhealthful foods — fatty, salty, sugary, processed foods — may disrupt the body’s defenses in a way that promotes inflammation, infection, autoimmune diseases and even illnesses like cancer.” And the link to that result was gut bacteria.

The bottom line is that you are the caretaker of your microbiome. Trillions of bacteria in your gut depend on you to maintain their health and diversity. And report after report is confirming that if you take care of them, they will take care of you.

OK, simple enough. What do these little fellas like?

Well, it turns out they don’t like red meat. At least not regularly. But they do like dietary fiber. Dr. Narula, on CBS, urged us to eat less red meat and processed foods, and more fruits, veggies, and high-fiber foods. She also recommended probiotic foods containing bacteria, such as yogurt, fermented foods, and soft cheese.

Changing your diet to favor foods high in fiber is a key strategy to a happy microbiome. But there is lots of conflicting advice out there, and misleading claims and labels on food products. Harvard Health has come to your rescue. Using only two numbers from the nutritional label that adorns all retail food items, you can select those high in fiber. They call it the 10-in-1 rule and here’s how you do it:

1.       Locate the “Total Carbohydrates” number on the label. It will be in grams, for instance 23g.

2.       Immediately below that, find the “Dietary Fiber” number. Let’s say its 5g.

3.       Divide the Total Carbohydrates number by 10: 23/10 = 2.3

4.       Now compare that result to the Dietary Fiber number: 2.3 is less than 5.

This is a good selection for a high fiber diet. You could further shop around for another brand that offered an even better ratio. The lower, the better.

Here’s another example. A common brand of potato chips has these numbers:

·         Total Carbohydrates – 25g

·         Dietary Fiber – 2g

Nope – 25g divided by 10 is 2.5, and 2.5 is greater than the 2g of dietary fiber. This is not a good choice.

In addition to labels on food items at the grocery store, you can use the web to find the equivalent nutrition label for a variety of foods. What you will find might surprise you. Mashed potatoes have more dietary fiber than white rice. Brown rice is better than mashed. But a baked potato, skin on, dressed with olive oil and vinegar like a salad, is a sound high-fiber choice.

And then there are the real surprises. While candy and chocolate bars fail the fiber test miserably, there is an exception: a dark chocolate bar with 90% cocoa and minimal sugar qualifies as a high fiber food.

Yes, you can make both you and your microbiome happy. Good eating.

We are not alone

Science News Magazine has been published since 1922, over ninety years. The news arm of the non-profit Society for Science and the Public educates and informs the public about current happenings in science and technology. It has covered such seminal events as the first man-made nuclear reaction, the first electronic computers, man’s first walk on the Moon, and the first jet aircraft. For some time, the editors have selected the top science story of each year.

For 2013, there were plenty of candidates. The amazing rise of miniature unmanned aerial vehicles (drones). Gene therapy advances in managing blood cancers. The ability to grow replacement organs from scratch. The Nobel prize in physics for the discovery of the Higgs boson.

But what was the top science story of 2013? Bugs.

Or more precisely, bacteria and other organisms which make up the microbiota living on and within the human body.

In a steady stream of studies and reports throughout the year, we learned more and more about our remarkable little cousins. For instance, the fact that only 10 percent of your cells are human; the other 90 percent are a mixture of bacteria, fungi, and viruses. (That microbes are so tiny and human cells relatively huge accounts for the fact that, by mass, our microbiota only amounts to a few pounds).

Scientists are even beginning to argue that we should view the human body as a superorganism defined by this mixture of human and microorganism DNA (microbiome). The advantage in doing so is that it might help us better understand the effects of diet, chemical exposure, and other factors on our health.

It is important to note that our community of microorganisms is for the most part beneficial. They help us digest food and convert it more efficiently to energy. They influence the immune system, training it to identify and fight true pathogens. They produce hormones instructing our body to store fats, and create necessary vitamins. To understand the workings of the human body without considering our microbiome is, we are finding, impossible.

Michael Pollan, in an in-depth New York Times Magazine article (“Some of My Best Friends are Germs”, May 15, 2013), details his research into this new frontier. Starting with a submission of swabs to the BioFrontiers Institute at the University of Colorado, he received a detailed report of his personal microbiome. Pollan interviews the scientists involved in the project and describes how our microbiome, unique as a fingerprint, is developed. Soon after birth, a community of microbes takes hold in the infant gut. Its composition from there is influenced by environment and, mostly, diet. In fact, the BioFrontiers scientists can identify from a person’s swab samples both where they live in the world and what is the makeup of their diet.

Researchers have observed that obesity may be encouraged by a certain mix of gut flora. And that mix of flora is a result of diet. Meat eaters have a distinct pattern of gut flora from vegetarians. Diets high in sugars and fats are quickly absorbed, denying nutrition to our little minions. They prefer diets high in fiber and complex carbohydrates; these take much longer to digest. What a surprise, then, to see that independent research into low glycemic index (GI) diets have concluded that diets high in fiber and complex carbohydrates are highly preferable for health. The microbes are the key, and they live or die by our dietary choices.

So what might this flood of human microbiome research mean? Perhaps we’ll find that our war on bacteria, with a plethora of antibiotic soaps and cleaning products, might be taking a toll on our little helpers. Certainly we need to be concerned with pathogens, but perhaps we are overdoing it.

We might find that diet books of the future will focus on cooking for our whole selves. Lightly cooked vegetables, whole grains, al dente pasta, for instance, all take longer to digest and provide the fiber that our gut bacteria thrive on. Feed them well and they will serve us well. It would be a complete change in perspective and provide a grand new toolset for managing obesity and optimizing health.

There is much research yet to do and understanding to be gained. But it is exciting that we are beginning to comprehend the owner’s guide to the whole human being.

Thin can be contagious - really!

In the old days, our moms would paint our scratches and nicks with Mercurochrome or, heaven forbid, Merthiolate, which stung like the devil. The goal was to hold the germs at bay. We had a pretty clear idea that our skin was a clear dividing line between that which is us and that which is not. And germs of all kinds were to be kept out.

But to our surprise, we are increasingly finding that some germs, species of bacteria called gut flora in particular, are not only harmless but downright beneficial.

The human digestive system contains trillions of bacteria weighing in at two to four pounds and actually outnumbering the human cells in our body. Gut flora help us process nutrients, harvest energy, create certain vitamins, and provide protection from pathogens. This symbiotic relationship is very complex, one of which we are still just scratching the surface.

Now a new study (Science, September 6) has given us a fresh sense of wonder about our tiny cousins. The surprising finding is that, not only do fat people and thin people have different species of bacteria in their guts, but those bacteria can actually influence obesity.

The study centered around a set of rare human twins, one of which was fat and the other thin. When laboratory mice received bacteria from the obese twin, they started to become fat. Mice receiving bacteria from the lean twin stayed thin. Here is the really interesting part: when the mice were comingled and bacteria in their guts were able to compete, the “thin” bacteria won the competition, infected the guts of obese mice, and kept their new hosts from gaining weight.

So far so good. But if these thin bacteria are naturally dominant, why aren’t there raging epidemics of leanness spreading across the continent?

The answer is diet. The thin bacteria were dominant when the mice were fed a low-fat, high-fiber diet. But when researchers changed that to a high-fat, low-fiber diet (more typically American ), the thin bacteria lost their dominance. They were still able to keep lean mice thin, but they were unable to establish a presence in the guts of obese mice.

The research is promising and bacterial weight therapy may be in our future. But, unfortunately, nothing that will overcome a diet of cheeseburgers and fries.

Why do we care? Because the negative effects of obesity are so severe. The CDC cites research showing that when weight increases to “overweight” or “obese,” the risk of the following conditions rises significantly:

•     Coronary heart disease
•     Type 2 diabetes
•     Cancers (endometrial, breast, and colon)
•     Hypertension (high blood pressure)
•     Dyslipidemia (for example, high total cholesterol or high levels of triglycerides)
•     Stroke
•     Liver and Gallbladder disease
•     Sleep apnea and respiratory problems
•     Osteoarthritis (a degeneration of cartilage and its underlying bone within a joint)
•     Gynecological problems (abnormal menses, infertility)

The health effects are enormous; the impact on quality of life is tragic. And the economic impact is huge, estimated at $147 billion per year. Now that we are all in the same taxpayer-subsidized health insurance risk pool, that should make you take note.

Michelle Obama is right. As a nation, we need to begin moving to a diet which is more low-fat and high-fiber on average.In fact, if we were all to pretend we were pre-diabetic and took up a low GI (glycemic index) diet, our collective weight loss would be measured in megatons.

An apple a day, indeed, may keep the doctor away.

Socialization and social comity

President William Howard Taft

The CDC has spoken and we are fat. The worst state, Mississippi, has an obesity rate of 35%. Massachusetts, the third best, has nothing to brag about with nearly one out of four citizens tipping the scales at “unhealthy.” This 2011 study was based on self-reporting and people tend to gild the lily. Another more rigorous report which involved weighing participants estimates that 36% of all Americans are overweight.  We are in the midst of a true epidemic.

Obesity is serious because it increases the incidence of diabetes, heart disease, cancer, and stroke among other ailments. Quality of life is worsened and mortality rate increased. Obesity results in significantly elevated health care costs.  And while it is easy to make rationalizations, obesity is a choice. What and how much we put in our mouths, whether and how frequently we exercise; these are personal choices.

We hear the term “socialization” tossed about frequently. By this, we don’t mean the process of making your puppy play well with others, but rather, the spreading of risks and costs across a large group of people.

It is a familiar concept.  One common example of socializing risk is automobile insurance.  Every driver (at least in Massachusetts) is required to carry automobile insurance.  In a given period, not everyone will have an accident, but everyone pays premiums.  The unlucky few who actually suffer a loss are compensated from the pool.

But this is not, in itself, socialization of risk.  If a 19-year-old from Roxbury paid a premium based on his actual risk of loss, it might be $10,000 per year.  Meanwhile, a 50-year-old woman in rural western Massachusetts might pay only $400.  But that’s not how we do it.  The state, in its wisdom, has deemed that we should all pay more so that the young scofflaw in Roxbury pays less.  This is true socialization of risk, the salient point being that it is actuarially unfair. (Unfair in that the woman from western Mass, along with most of us, pay more than we should while the young man pays far less than he should). This leveling of risk premium removes from the young man in Roxbury the incentive to drive exceedingly carefully.

In other words, socialization of risk distorts our decision making process and leads to more risky behavior (because risk, and hence cost to the individual, is subsidized).  It is always true that to get less of something, tax it; to get more, subsidize it. Subsidizing risky behavior is a sure fire way to get more.

Any form of national health care is another variety of risk socialization. Our increasingly socialized health care system does not charge premiums based on risk factors.  For instance, an inveterate rock climber does not pay higher health insurance premiums than you do, but she takes much greater risks.  Likewise, a motorcycle racer, skier, pilot, scuba diver, or lumberjack do not pay higher premiums than you do.  Health risks are subsidized.

It was different in an earlier era.

William Howard Taft, our 27th president, served from 1909-1913.  He was morbidly obese, suffered from high blood pressure, severe sleep apnea, and died of a heart attack. But at that time, each was responsible for his own behaviors and the resultant consequences. Taft ate richly and drank to excess, did not exercise, packed on the pounds, and suffered poor health as a result. But no one had to pay Taft’s physician except Taft.

In this day of increasingly socialized medicine, where poor personal choices engender no individual costs but burden the public fisc, it is difficult to observe such profligacy without comment, or at least smoldering resentment.  Socialization is making us downright rude.

But government, which is adept in creating such a mess, can further intervene. A recent article in The Telegraph (London) offered such a solution:

“Ridiculing someone as 'fat' or 'obese' could become a hate crime under an idea being floated by a group of MPs and a leading charity.”

This is a solution of sorts.