Not all fatness indicates disease risk. Not all leanness indicates lack of disease risk. So what is the one factor that is a potent indicator of disease risk? It is an inflammatory process called metaflammation, para-flammation or smouldering inflammation. This condition appears to be inextricably linked with individual lifestyle behaviours like:

1. poor diet
2. inactivity
3. excessive exercise (modern endurance events)
4. inadequate sleep (due to deprivation, insomnia or sleep disorders like sleep apnoea)
5. mental states like anxiety or depression
6. environmental stressors
7. excessive alcohol
8. smoking

Markers of inflammation are expressed through a range of immune mediators such as cytokines, chemokines, adipokines, myokines and transcription factors. Recently, C-reactive protein has gained more attention than NFkB, TNF alpha and Il-6 but overall, these are common markers used to identify unhealthy inducers of metaflammation. It seems, the lifestyle-related inducers listed above are associated with oxidative stress, insulin resistance and eventual development of disease states.
Regularly consuming high glycaemic foods or large quantities of highly processed carbohydrate foods leads to inflammation and aging of cells. As Professor Jennie Brand Miller, world leading authority on the glycaemic index puts it very simply, “High GI foods lead to high inflammatory markers due to oxidative stress. What happens is that the high glucose load overwhelms the power-house (mitochondria) in the cell causing lots of free radicals to be generated. This leads to death of the mitochondria and eventual cell death.” In essence, aspire to eat like traditional natives and regularly choose low GI foods.
Regular moderate level physical activity, approximately ½ to 1 hour per day most days of the week is anti-inflammatory. Getting 8 hours of good quality sleep daily is also vital. It appears that the “stress-like’’ effects of sleep deprivation and the accompanying hormonal changes are associated with obesity.
In an advanced society like ours, mental states associated with stress, anxiety and depression seem to generate acute inflammatory responses accompanied by elevated levels of cytokines. Smoking also elicits a parallel reaction. Both of which are linked to degenerative diseases.
In a nutshell, the maintenance of a disease-free state lies squarely in our hands. Health is about consistently choosing pro-life behaviours through good nutrition, exercise, good quality sleep, relaxation and powerfully choosing joy-filled states. What are your views? Please post you comments below.

Australians are among the fattest people in the world. This has caused a host of chronic diseases to develop. A cluster of some of the above-mentioned conditions is commonly called metabolic syndrome. It is often said that obesity is harder to cure than cancer! For over 10 years, it has been known that obesity is directly associated with inflammation.

More and more experts are seeing body weight or fat as potential ‘markers’ of other health problems, like cancer, heart disease and diabetes. Low grade form of inflammation commonly called metaflammation seems to result from certain lifestyle behaviours. Some of these behaviours are responsible for making us fat.

Certain food choices and lack of activity are now known to contribute notoriously to ‘metaflammation’. According to studies, merely changing or reducing weight without adopting all aspects of lifestyle changes aimed at reducing inflammation are doomed to fail in the long run. To achieve better overall health outcomes, all aspects of lifestyle that contribute to reducing inflammation should be adopted.
Sleep is a factor that is largely neglected in our modern society. We now know that less than 7 hours sleep a day has been shown to raise inflammatory makers. This is related to psychological stress which has been known to cause pro-inflammatory responses. Chronic stress causes a chronic rise in stress-related hormones like cortisol and the concurrent reduction in the ‘feel-good’ hormones – endorphins. Chronic stress and depression are directly associated with metaflammation. Metaflammation leads to numerous disease states as a result of insulin resistance! In other words, science has shown that you can sleep yourself and relax yourself slim! Wow, how awesome is that? If you did nothing else but get good quality sleep and adopt deep relaxation, you could be a few kilograms lighter than you are now! How is that for good news?

Hence the winning formula for keeping trim involves a complete lifestyle overhaul combining:
1. Good sleep
2. Stress management (so you have little or no stress in your life)
3. Plenty of exercise – take every opportunity to move!
4. Good solid ‘anti-inflammatory’ diet filled with back-to-basics ‘earth foods’
5. No smoking

All of these health-enhancing factors have not changed since the time of Hippocrates. How remarkable is that? These 5 simple factors make up the entire prevention armoury. They say the more things change the more they stay the same, this must be one of those things!

1. Thou shalt nurture your spirit
How much time do you spend each day nurturing yourself? Do you do something each day that makes you smile or inspires you so that you feel good about yourself? When was the last time you laughed so hard that you cried? Remember how it was when you were a child and there was no holding back? Life was filled with infinite possibilities and you were free to create whatever you wanted in your mind’s eye? You were courageous and your view of the world was simple. You never wasted a moment on the past and you approached the future fearlessly and you were always deeply engaged in the present moment. How has the world changed since you were a child? Probably not that much but you have changed and complicated everything. What happened? When was the last time you spent time day dreaming and smiling to yourself? Nourishing your spirit is the first step to successful long term weight loss. How do you nourish your spirit each day? If your answer is, “No, I am too busy to engage in such nonsense.”, think again, you might be missing out on some of the finest things in life that money cannot buy – loving yourself and being happy. Start by asking yourself what are the things in your life you would love to do that make you happy and relaxed? Make a list and be sure to include some of these activities in your busy schedule everyday.

2. Thou shalt eat wholesome, natural foods
“When you sit to dine with a ruler, note well what is before you and put a knife to your throat if you are given to gluttony. Do not crave his delicacies, for that food is deceptive” Proverbs 23:1-3
Even in biblical times, there were clear warnings about the dangers of rich foods! How much processed foods do you eat in the day? How much of these foods come carefully wrapped in lovely paper wraps, boxes, tins, plastic bags, cartons, PVC bottles and glass bottles? All with mandatory food labels on them indicating the amounts of macronutrients and calories per serve or per 100g portions. We have an obsessive ‘love affair’ with rich foods that is threatening the health of the entire Western world. How often do you go back to basics and eat the “foods of the earth” as they were meant to be eaten – unprocessed, raw! The dietary guidelines clearly state you must eat 5 serves (cups) of uncooked vegetables and 2 serve of fruits each day and 4 serves of calcium-rich foods (like two small tubs of yoghurt and two glasses of low fat milk). Imagine if this was the foundation of your daily eating plan, how much more other foods can you include in your diet? I’d dare to say not much more as you would be too full to eat too much more of anything else. That makes weight loss a breeze!

3. Thou shalt have a trim tummy
How big is your tummy? Excess abdominal fat is not only ugly but also a serious risk factor to your health. There are two types of abdominal fats namely subcutaneous and visceral fat. The former refers to fat under the skin and on top of the abdominal muscles while the latter refers to fat found beneath your abdominal muscles, surrounding your vital internal organs. Visceral fat is much more dangerous than abdominal fat as this fat can enter the liver from these abdominal stores and cause “insulin resistance”. Insulin resistance signals the pancreas to produce more insulin in the vain effort to push circulating blood sugars into cells. This often sets up a viscous cycle leading to the use of drugs that supply even more insulin. A large quantity of circulating insulin is associated with high blood pressure, diabetes, heart disease, stroke, sleep apnoea, certain cancers and degenerative diseases! How much does your waist measure? Get the tape measure out right now and measure yourself across your belly button. Men with waist measurements greater than 94cm and women with waist measurements greater than 80cm are predisposed to chronic diseases! Take action now to reduce your waist before it is too late.

4. Thou shalt be active
Do you make an effort to move at least 30minutes a day? If you cannot exercise for 30 minutes, just combine 3 lots of 10minutes of moderate to intense exercise. That will also do. This is the bare minimum to maintain basic fitness levels. They say you get out of life what you put in. So, for the extraordinary result you so desire try the following: for example, if your office is located on level 9 of a high-rise building, it will take approximately 10-15 minutes to walk up the stairs of the building. Do this 4 times a day (when you arrive, go out for lunch, return from lunch and when you go home). It will easily total 1 hour of exercise! How easy is that? Get the “hot bod” you have always wanted without even trying! Who needs to go to a gym regularly? If you do nothing else but this, I assure you, you will not recognize yourself after one year. Transforming your activity naturally leads to transforming your food choices and the result will be phenomenal.

5. Thou shalt drink alcoholic beverages in moderation only
Men should not drink more than 4 standard drinks and women not more than 2 standard drinks a day. The house wine you get at your restaurant is almost 2 standard drinks. A can of beer constitutes 1.5 standard drinks. How many and how often are you drinking? Do you have two alcohol-free days a week? Alcohol has more than twice as many calories as fat. Naturally the more you drink the fatter you will be!

6. Thou shalt eat until you are comfortably full
How often do we stuff our faces till we cannot walk? Is it three times a year – at Christmas’, New Years’ and on your birthday? If that is all then it is not a problem. If it happens 3 times a day then you have a serious over-eating disorder at hand, you have to seek professional help. A psychologist or dietitian specializing in eating disorder would be my first port of call. Take a moment today to go internally and feel your body cues. You will know it when you are comfortably full, that is about 7/10 full. That is the point you should stop eating and walk away from the table. Practice this everyday at every meal. I would be very surprised if you do not lose some weight or even a lot of weight without changing anything else!

7. Thou shalt stay hydrated
Most people do not drink enough fluid in the day. Ideally we should aim for 8 glasses of fluid or 2 liters of fluid a day. Next time you feel “hungry”, pause for a moment and ask yourself if you are really hungry or thirsty. Often thirst is mistaken for hunger and you end up eating excessively.

8. Thou shalt eat slowly
How fast are you eating? Studies have found that the speed at which someone eats their food is often directly proportional to their body size. The faster you eat the more likely you are to be over weight. Tonight when you sit down to have dinner, watch the wall clock and check how much time you take to eat. You should take at least 20 minutes - chew your food thoroughly before swallowing. If you take 30 minutes to eat that is even better. It tells me you are practicing mindful eating and most likely enjoying your food and much less likely to overeat and get heart burn. The act of chewing food thoroughly tends to make one feel more satisfied and fuller.

9. Thou shalt eat at the table
How often do you eat on the run? Do you eat all edible morsels from your children’s leftovers? Do you eat a Mars bar at the bus stop because you felt ‘peckish’? Would you polish up a slice of cheese, half a leftover poppet of fruit juice, 5 snakes, 3 biscuits and ½ a packet of chips on the run and discount them as part your caloric intake because they were not eaten at the dining table? Well, if you are serious about losing weight, stop eating on the run at once and have 3 main meals a day properly at the dining table!

10. Thou shalt not eat when overly hungry
How often do you come home from work in the late afternoon and plunder your refrigerator and pantry? Do you feel so hungry that you can eat every edible morsel in your path? Well, stop pronto when you are in that state. Drink a glass of water and eat a fruit like an apple (something that requires a lot of chewing before swallowing to starve off the hunger pangs), regroup and then start planning a proper dinner. That way you are less likely to overeat and choose unhealthy food choices.
 
Conclusion
So these are the ten commandments for effective weight management. What do you think? Have you had your own experiences of what works for you? Which parts do you find easier and which ones harder? Any area you would like me to expand on in a future article?
Please leave me a comment below.

In this article I will show you what they are and give you some scientific background on how they were discovered and how they work.

In the 1950s, Ancel Keys found that he could accurately predict the effect of a vegetable oil on blood cholesterol simply based on its saturated and polysaturated fat content.  This predictive value however failed with maize oil and he called this the ’maize oil abberation’.  Little did Keys know that he was actually observing the cholesterol lowering effect of plant sterols we now know is abundantly present in maize oil!  

Plant sterols and stanols are phytosterols. They are essential components of plant membranes. Rich sources of plant sterols are found in vegetable oils (especially fortified margarines), salad dressings, nuts and seeds. In 2002, Ostlund et al discovered in very carefully controlled studies, that very modest intakes of 0.3 or 0.4g/day of plant sterols can reduce cholesterol absorption in the gut by a whopping 38%!

How do plant sterols do that? Plant sterols and cholesterol share similar chemical structure. As such, plant sterols can restrict cholesterol absorption by competing with and blocking absorption of cholesterol from the intestine. This effectively reduces cholesterol absorbed into the body resulting in lower blood cholesterol levels. Please note that a side effect of this is the concomitant reduction in the absorption of beta-carotene and lycopene from carrots, beetroot and tomatoes. Therefore it might be necessary to have one more serve of carotenoid-rich fruit or vegetable to compensate for the reduced absorption of these specific nutrients.

More than 50% of Australians have high blood cholesterol levels. This is equivalent to approximately 6.4M adults. Studies have shown quite conclusively that reducing blood cholesterol level by as little as 10% can significantly improve cardiovascular outcomes by 20%. In fact, it has been demonstrated that adding plant sterols/stanols to the diet acts synergistically with statins to reduce blood cholesterol more effectively than doubling the quantity of statins. What I am alluding to here is the possibility that plant sterols are even more potent than statins in lowering blood cholesterol levels! As if this is not enough, as I write, a growing body of evidence is gathering in support of the view that plant sterols may also reduce the risk of stomach, colon, breast and prostate cancers! What a nice bonus!

The plant sterol content of Japanese diet is more than 4 times that of the typical Western diet. This is fundamentally because kelp and other seaweeds commonly found in Japanese diet are rich in sterols. Could this be one the reasons why people in Asian countries exhibit significantly less degenerative diseases than those in the highly industrialized nations?

Hence, how much plant sterols do you need to eat per day? The answer is 1.6-2.4g/day.

Where can you find plant sterols?

References
1. Australian Institute of Health and Welfare (AIHW) 2004. Heart, stroke and vascular disease – Australian facts 2004. AIHW Cat. No. CVD 27. Canberra: AIHW and National Heart Foundation of Australia (Cardiovascular Disease Series No. 22).
2. Zhang X, Patel A, Horibe H, Wu Z, Barzi F, Rodgers F, Rodgers A, MacMahon S, Woodward M and Asia Pacific Cohort Studies Collaboration: Cholesterol, coronary heart disease and stroke in the Asia Pacific region. Int J Epidemiol. Aug; 32: 563-72, 2003.
3. Law M. Plant sterol and stanol margarines and health. BMJ 2000; 320:861-864.
4. Noakes M, Clifton P, Ntanois F, et al. An increase in dietary carotenoids when consuming plant sterol or stanol esters is effective in maintaining plasma carotenoid concentrations. Am J Clin Nutri 2002; 75: 79-86.
5. Nestel PJ, Cehun M, Pomeroy S et al. Cholesterol-lowering effect of plant sterol ester and non-esterified stanols in margarine, butter and low-fat foods. Eur J Clin Nutr 2001; 55: 1084-1090.
6. Awad AB, fink CS. Phytosterols as anticancer dietary components: Evidence and mechanism of action. J Nutri. 2000; 130(9): 2127-30.
7. Piironen V, Toivo J, Puupponen-Pimia R, Lampi AM. Plant sterols in vegetables, fruits and berries. J Sci Food Agric. 2003; 83:330-337.
8. Abbey M, Noaks M, Belling GB and Nestel PJ. Partial replacement of saturated fatty acids with almonds and walnuts lowers total plasma cholesterol and low density lipoprotein cholesterol. Am J Clin Nutr 1994; 59. 995-999.

PCOS can occur at any age. Insulin resistance tends to rise naturally at puberty. Symptoms of PCOS vary tremendously from individual to individual. Examples of symptoms are: irregular / infrequent menstrual cycles, infertility,  acne, acanthosis nigricans (rough dark-coloured skin around neck and armpits), heavy body- hair, hirsutism, stubborn body fat, inexplicable tiredness with acute drop in blood pressure on standing up or with exercise, post-meal low blood sugar levels, sleep apnoea and general reduced stress threshold.  Do you have any combination of these symptoms?  If you do, make an appointment to see your doctor.

Diet, exercise and medication are prime tools for successful management of PCOS. It is imperative that a good structure involving adequate exercise, low glycaemic index eating plan and right medication be put in place to assist PCOS sufferers to rebalance hormones (insulin, luteinizing hormone, testosterone), improve insulin sensitivity and significantly reduce symptoms of PCOS.

What are low glycaemic index foods? They are fundamentally foods containing carbohydrate that breakdown slowly to release sugar (glucose) into the bloodstream gradually. Choosing low glycaemic index (GI) foods will lower your insulin levels. And lowering insulin levels will enhance fat burning and reduce fat storage. Naturally this will assist weight loss! Examples of low GI common foods are:

Glycaemic Load = (GI x carbohydrate per serve) / 100

Food items with high carbohydrate content have high glycaemic load.  Large scale studies from Harvard University indicate that frequent consumption of high GL and high GI foods appear to be synonymous with adverse health outcomes.  

Drugs, metformin and thiazolidinediones, are commonly prescribed for enhancing insulin sensitivity in the treatment of PCOS. Please note that metformin may interfere with vitamin B12 absorption, so it may be necessary to have regular blood tests to ensure vitamin B12 levels are good.  In B12 deficiency of this nature, consuming B12-rich foods like meat, dairy products, fish, shellfish and poultry may not be sufficient to correct the problem.  Monthly injections of vitamin B12 subcutaneously or intramuscularly should be considered.  In severe cases of hirsutism, drugs that block the effect of male hormone – testosterone, like spiranolactone and finasteride are also prescribed.  Oral contraceptive pills (i.e. Dianette) are also often prescribed to increase circulating oestrogen levels and suppress ovarian function. 

In summary, medical management of PCOS lies in lifestyle modification with low GI diet, exercise and pharmacological treatment. In most cases, this lifestyle change has to be life long.

Footnote: For more information on glycaemic index go to http://www.glycemicindex.com/

In 2007, Professor Jennie Brand-Miller et al demonstrated in a simple but elegantly designed experiment to demonstrate the effect of alcohol (from beer, wine and gin) on blood sugar levels after a meal and found some astounding results.

This study found that alcohol has the potent ability to reduce blood sugar response after a meal. Of the 3 alcoholic beverages tested, wine was found to have the greatest blood sugar lowering effect (lowering the glucose score by 37%).

How can we explain this amazing result? Well, it is possible that alcohol may inhibit the production of glucose from our liver. Also, alcohol seems to slightly increase insulin sensitivity resulting in less sugar circulating in the blood. This ability to create a flatter blood sugar response or curbing sugar ‘spikes’ is vital in the prevention of heart disease and the control of symptoms of metabolic syndrome.

Hence, moderate intakes of alcoholic beverages particularly – wine (100ml per day), could be an important part of a healthy diet! As Jean-Anthelme Brillat-Savarin said, “A meal without wine is like a day without sunshine.”

References

1. Brand-Miller J et al. Am J Clin Nutri 2007; 85:1545-51.
2. Brand-Miller j et al. Curr Atheroscler Rep 2007; 9:479-85.

Quite on the contrary, linoleic acid (omega-6 fatty acid) has been proven to be the most potent cholesterol-lowering nutrient in the diet with impressive cardiovascular benefits (20-35% reduction in clinical cardiovascular end-points) according to a study by Ascherio in 2002. Where can you find omega-6 fatty acids?
They are found in:
1. walnuts
2. sunflower oil
3. sunflower seeds
4. sunflower margarine spread

In the 1980s, two lines of evidence came together on the cardio-protective effect of omega-3 fatty acids. Firstly, epidemiological studies proved beyond any shadow of doubt that populations eating large quantities of fish have very low rates of heart disease. A meta-analysis by He et al found that 5 or more fish meals a week was associated with a 40% reduction in cardiovascular disease. Secondly, long chain omega-3 fatty acids were shown to significantly lower blood fats (triglycerides), reduce inflammation, blood thinning (anti-thrombotic) and relax blood vessels (vasodilatory). All factors are beneficial for lowering cardiovascular risks.

Fish that live in cold water are rich in omega-3 poly unsaturated fatty acids – particularly docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA) and docosapentaenoic acid (DPA). The NHMRC Nutrient Reference Value for EPA, DPA and DHA is 160mg/day for men and 90mg/day for women. To prevent chronic disease, the values have been set at the 90th percentile. At this level, the targets for omega-3 fatty acids have been revised higher to 610mg/day for men and 430mg/day for women respectively. Where can you find these fatty acids?

From the above table, it is obvious that fish provide the highest quantity of omega-3 fatty acids. A 610mg per day target for men translates into approximately 100g of fish most days of the week! The upper limit for children, adolescents and adults are currently set at 3000mg/day. The GISSI – Prevenzione intervention study found that intake of 850mg of EPA and DHA significantly reduced the risk of sudden cardiac death by 45%. Dietary intake of 850mg of omega-3 fatty acids could be difficult to achieve on a daily basis. One may consider a 1000mg/day fish oil supplement as a preventative measure.

In 2000, De Catherina et al found that both omega-6 fatty acids and omega-3 fatty acids have anti-inflammatory properties; the protective effect appears to increase depending on how unsaturated the molecules (i.e. the number of double bonds). With this new evidence, Nutrient Reference Values have been formally set for these nutrients. The NRV for adequate intake of omega-3 (alpa-linolenic acid) and omega-6 fatty acids (linoleic acid) are 1.3g/day and 13g/day respectively for men and 0.8g/day and 8g/day respectively for women.

Strong scientific evidence linking dietary deficiency of omega-3s with increase risk for cardiovascular events has lead to the creation of the Omega-3 Index (by Clemens von Schacky and Bill Harris). Essentially, the Omega-3 Index represents the percentage of EPA and DHA in red blood cell membranes.
This Index is a measure of the omega-3 status of an individual. As I write, this index is increasingly being used as a valid risk factor for heart disease!

References

1. He K et al. Circulation 2004; 109:2705-11.
2. Sands SA et al. Lipids 2005; 40:343-7.
3. Harris WS. Pharmacol Res 2007; 55:217-223.
4. Sacks FM, Campos H. J Clin Endocrinol Metab 2006; 91:398-400.
5. Asherio A, Am J Med 2002; 113:9S-12S.
6. De Caterina R et al. Am J Clin Nutr 2000; 71:213S-223S.
7. Ferrucci L et al. J Clin Endocrinol Metab 2006; 91:439-446.

Examples of common processed foods and their corresponding salt content are listed below:

References
1. Asaria P et al. Lancet, 2007; 370:2044-53.
2. World Health Organisation, Reducing Salt Intake in Populations. Geneva: WHO; 2007