FOREVER  YOUNG  -  the  book  -  parts  of  chapter  three



THE METABOLIC MIRACLE:


LOSING FAT, PRESERVING MUSCLE AND BONE



With obesity on the rise in America, weight loss has become a national obsession. We are awash in a plethora of different weight-loss programs and countless weight-loss supplements. Unfortunately, rather than waning, obesity appears to be on the rise, so it is no surprise that we are a nation obsessed with dieting, diet books, diet foods, and diet fads. Our quest for weight loss is as unending as it is unsuccessful. But who knew that that hard-earned 5-, 10-, or more-pound weight loss was destroying both muscle and bone, with far-reaching deleterious effects? The fact is that the wrong kind of dieting increases our levels of inflammatory markers and accelerates the loss of precious muscle mass. Unfortunately, this is not the only problem with conventional dieting/ weight loss "wisdom." Dieting is a key culprit in declining bone mass-density (BMD). We are never informed that weight loss, including loss facilitated surgically through gastric bypass or banding procedures, has been/repeatedly documented as depleting bone density and increasing fracture risk.


Risky Business


I was a coinvestigator on a study on sarcopenia, the progressive loss of muscle tissue with age, titled "Sarcopenia: When Weight Loss Is Counter-Productive" with colleagues including Harry Preuss, M:D. M.A.C.N., C.N.S., at the Department of Physiology, Georgetown University Medical Center. The idea that weight loss in an otherwise healthy person could be counterproductive seems hard to believe, but as you will discover, the wrong kind of weight loss can wreak havoc on both your muscle tissue and your bones.


Skeletal muscle mass and strength generally peak between 20 and 35 years of age. From then on, 3 to 8 percent of muscle mass maybe lost per decade, a loss rate that has previously been reported to accelerate after the age of 60. We have long known that with each passing decade we tend to lose 5 pounds of muscle mass and gain 10 pounds of body fat. My own research has shown that dieting can speed up this loss.


As we age, we develop an increased risk for osteopenia and osteoporosis. 


Osteopenia can be defined as the thinning of bone mass, most common in postmenopausal women due to a lack of estrogen. This decrease in bone mass is not usually considered severe, but it is considered a very serious risk factor for the development of osteoporosis. Health experts are well aware that osteopenia and osteoporosis are consequences of the age-related decline in bone density, but few are cognizant of the deleterious effects of sarcopenia.


In this chapter, I will tell you about a "metabolic miracle," an efficient way to say good-bye to body fat. In these pages you will learn the secret of body fat, how to minimize the risks of weight loss, and how to prevent and/or reverse this trend of muscle and bone density loss. You will gain a new understanding of the role that toxins play in weight gain and how to beat them at their own game.


Understanding Sarcopenia and the Importance of Muscle Versus Fat


Sarcopenia differs from the involuntary muscle depletion that is seen when our nutrition is inadequate or caused by starvation or diseases like cancer or AIDS. It is also distinct from cachexia, a cytokine-driven loss of lean body mass that occurs despite maintenance of body weight. Sarcopenia is sometimes seen in patients with rheumatoid arthritis, congestive heart failure, or renal (kidney) failure. As Ronenn Rou-benoff and Carmen Castaneda wrote in a paper titled "Sarcopenia— Understanding the Dynamics of Aging Muscle," published in The Journal of the American Medical Association, "Sarcopenia is not a disease . . . but is the backdrop against which the drama of disease is played out: a body already depleted of protein because of aging is less able to withstand the protein catabolism that comes with acute illness or inadequate protein intake." 


As you will learn in the Metabolic Miracle diet described in these pages, supplying protein in an efficient absorbable form with the right supportive nutrients can sustain muscle and reverse the trend of catabolism, or breakdown.


Although cachexia generally connotes a state of advanced malnutrition and wasting, we now know that this term refers more specifically to a loss of body cell mass. Studies of starvation, critical illness, and normal aging have found that a loss of body cell mass greater than 40 percent is fatal. Even with as little as 5 percent loss of body cell mass, there are demonstrable changes in morbidity (a diseased state), including loss of muscle strength, altered energy metabolism, and increased susceptibility to infections. Accompanying the muscle loss is a reduction in voluntary strength, about 30 percent between 50 and 70 years of age.


With the huge number of baby boomers aged 50-plus, we know how important it is to prevent this loss of critical muscle mass. Fortunately, this generation has a penchant for physical fitness. As I often write, we don't have to age like our parents. We have a choice, and my great joy in writing Forever Young is letting readers know their options. Too often we think of flabby, sagging muscles, potbellies, and excess body fat as simply an aesthetic problem. Nothing could be further from the truth. Body fat is toxic, and the loss of precious muscle mass and bone is equally deleterious to health and well-being.


The word "sarcopenia" is derived from the Greek root words sarx, meaning "flesh," and penza, meaning "loss." Sarcopenia has important consequences for balance, metabolism, physical appearance, general well-being, and quality of life. As the length of the human life span increases, the number of people suffering from sarcopenia is also projected to increase. Sarcopenia causes many problems because as it progresses, our mobility is further impaired, impeding the normal activities of daily living. This can result in osteoporosis, falls, fractures, thrombophlebitis, pulmonary embolism, isolation, depression, and other adverse consequences. An estimated 14 percent of people between the ages of 65 and 75 require assistance with the normal activities of daily living, and this figure increases to 45 percent for persons over 85 years of age. The medical effects and economic costs of sarcopenia are profound, and, as one reviewer has reported, "Sarcopenia is an important cause of frailty, disability, and loss of independence in the elderly, and recent estimates suggest that it costs the United States over $18 billion per year, a sum on par with the economic consequences of osteoporosis."


A Deadly Duo


Some studies suggest that sarcopenia is the major predictor of function limitations, while others suggest that it is the combination of obesity and sarcopenia that is the primary cause of disability. The implications are that the dangerous combination of sarcopenia and obesity in old age is more strongly associated with disability in daily living than either sarcopenia or obesity alone. As you can see, the implications for  disaster are enormous and the quality of life is severely compromised when muscle mass has been replaced with toxic body fat. The goal of the Perricone Forever Young Program is to keep you strong, fit, and active while maintaining a healthy weight.


Healthy Weight-Pulling the Scales from Our Eyes


Most people assume a healthy weight can be determined by the reading on the bathroom scale. But this is not an accurate assessment. It is not the amount of weight you lose that is the most important measure of well-being but rather the kind of weight you lose. The secret in determining healthy weight is your body composition index (BCI). If you gain 2 pounds of lean muscle mass and lose 2 pounds of body fat, your scale weight will not have changed, but you will be in better shape. Your goal is to lose body fat and maintain and/or restore muscle mass—not the other way around.


For overall beneficial health, health professionals and scientists do not pretend to know how many pounds of muscle it takes to offset gains in body fat or how much fat one has to lose to offset losses in muscle. What is clear is that loss of lean muscle and gain of body fat are clearly negative treatment outcomes, regardless of any changes in scale weight. The litmus test of a safe and efficacious weight loss program is the preservation of lean muscle and the depletion of excess body fat—in short, the kind, not amount, of weight that is lost.


The bad news is that some level of sarcopenia exists in all older individuals. In the face of acute or chronic illness, maximizing muscle mass and protein stores with adequate nutritional support, as you will learn in the Metabolic Miracle diet that follows, aggressive physical therapy, and exercise programs become all the more important if muscle function and quality of life are to be preserved as we age.


Living in Fat City


What is behind the increasing rate of obesity/sarcopenia plaguing the world? 


There are many reasons for it, foremost among them the superabundance of junk and processed "food" available today, so let us consider a few possibilities.


The primary treatment for improving the muscle/fat ratio is exercise and diet. 


In the case of muscle, it is generally accepted that most people get too little exercise. No one would disagree that such a state leads to a smaller muscle mass and a larger fat mass. 


As for the fat factor, dietary indiscretion is rampant everywhere. The public was first trained to focus on the saturated fat content of foods to avoid atherosclerosis and heart disease. Never mind that trans fats were ignored; excess calories and refined carbohydrates that often replaced the avoided saturated fats were also ignored. Consuming refined sugar, white flour, and other simple carbohydrates causes your insulin level to spike, because these carbohydrates break down quickly and turn into glucose in your bloodstream. 


Insulin regulates fat storage. When insulin levels are elevated, we store fat in adipose tissue; when they are low, fat is used as fuel. What you eat helps to maintain the right hormonal balance to produce energy at a steady level. Complex carbohydrates like whole grains, fresh fruits, vegetables, and beans are digested more slowly, leading to gradual and smaller increases in insulin. What you eat is used as energy for your body rather than stored as fat.


I have always contended that pro-inflammatory, easily digestible (high-glycemic) simple carbohydrates, not dietary fat, saturated or otherwise, are the major cause of obesity, heart disease, and many other chronic diseases of civilization, perhaps even sarcopenia. The message of reducing calories and avoiding fat has gained so much popularity that it is possible that such a diet may lead to even more sarcopenia. The unfortunate surfeit of nonfat and low-fat diets has been responsible for widespread avoidance of good fats like the omega-3s, which can be a factor in today's widespread depression and obesity, because we need healthy fats to metabolize fat.


In my first book, The Wrinkle Cure, and the seven that followed, I described a diet high in pro-inflammatory, high-glycemic foods— refined sugars and starches—as the culprit and causative factor in elevated blood sugar and insulin levels and resulting inflammation. This chronic, low-grade, subclinical inflammation is at the root of obesity and a host of age-related diseases and degenerative conditions from bone loss to sarcopenia, from arthritis to Alzheimer's, and so forth.


Getting Off the Roller-Coaster Ride


When we are overweight or obese, there is a constant exchange of fat for muscle. Improper dieting will greatly accelerate this exchange, because we have reduced our overall caloric intake. When we are significantly overweight, we experience chronically high insulin levels, which start to drop as soon as we start to diet. Though this might sound like a good thing, it is, in fact somewhat of a catch-22. Though low levels of insulin will decrease inflammation, allowing us to utilize the body fat for energy, insulin is required to bring protein into the cells to maintain muscle mass, a process known as the anabolic effect. Since overweight people have chronically high levels of circulating insulin, they become insensitive to decreased levels and cannot recognize these new lower levels. In this state, their bodies are unable to trigger the amino acid uptake needed to maintain muscle mass. Insulin is needed to take up both glucose and amino acids into the muscle. In addition to the loss of critical muscle and bone, being overweight or obese also increases your risk for type 2 diabetes. When we have excess body fat, we also have higher levels of inflammatory markers such as C-reactive protein and some of the interleukins. Transcription factors like NF-kB are also activated. Once NF-kB is activated, we become insulin-resistant.


This is why it is essential to take a powerful anti-inflammatory approach to dieting. Inflammatory chemicals like NF-kB block the effects of insulin—whether metabolizing blood sugar or nourishing muscles with amino acids. As I said before, the inflammation must be treated first. It is important to note that overexercising can further put us into a catabolic state, in which complex molecules are broken down into simpler ones. This happens because active muscles require more nutrients.






CLOCK WORK-

THE KEY TO BEAUTIFUL SKIN AND HEALTHY WEIGHT


I have often written about the importance of sleep for health and beauty, including numerous blogs on the Huffington Post. Providing a wonderful service to readers of her blog, Arianna Huffington has been very vocal about the importance of sleep. Right after New Year's, Arianna posted a Sleep Challenge 2010 to raise awareness about the serious problem of women suffering from sleep deprivation. Now more than ever, women have tremendous demands on their time and, as a consequence, suffer greatly from the lack of sleep. As you will discover, insufficient sleep seriously disrupts our health, our weight, our sense of well-being, and our skin.

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Sleeping Beauties


As some of the world's most beautiful and talented actresses converged on the red carpet at the 2010 Oscars, many wondered how they did it, looking so radiant and wonderful despite the grueling schedules they keep. This year's nominees included Helen Mirren, Sandra Bullock, Meryl Streep, Penelope Cruz, Mo'Nique, Carey Mulligan, Maggie Gyllenhaal, Gabourey Sidibe; Vera Farmiga, and Anna Kendrick, whose ages ranged from the early twenties to the early sixties, proving once again how ageless beauty can be.


Regardless of age, each star has her own unique style. And though I cannot profess to know their secrets, I can share with you some of my own secrets for radiant skin and a healthy body weight—it all saris with our internal clock and a good night's sleep.


We humans are creatures of habit, for better or worse. We like to set our meals at the same time, go to bed at the same time, and so on. There is an excellent reason for this. We all need to follow a daily Orcadian rhythm—that is, a rhythm based on the twenty-four-hour cycle, the time it takes the earth to make a full rotation on its axis.


For thousands of years this was not a problem: humans went to sleep when the sun went down and arose when the sun came up. But those days are long gone. It has become apparent that this is not a positive change, as scientists have discovered that disruption of this cycle causes us to develop a number of metabolic discords.


Staying up too late, snacking throughout the day, and skipping meals all upset the genes that control daily rhythms in the brain and throughout the body. One important finding is that the "clock," which scientists thought was only in the central part of the brain, is also present in the part of the brain that controls appetite. In fact, biological clocks function not only in the brain but in many other parts of the body as well. They govern not only the sleep cycle but also functions including fluid balance, body temperature, oxygen consumption—and now, it has been shown, appetite. Researchers at Northwestern University and the Howard Hughes Medical Institute have identified wide-ranging molecular and behavioral changes in mice that have a faulty circadian system. In people, similar changes in body fat and metabolic activity are known as metabolic syndrome.


Fred W. Turek, a member of the research team, stated that the study provided new genetic evidence that physiological outputs of the biological clock, sleep, and appetite are interconnected at the molecular and behavioral levels.


This research data give new credence to the concept that we are creatures of habit. Perhaps more important, it establishes the fact that we need to follow a regimen in our daily lives, one based on cycles as primary as the rising and setting of the sun, to which humans have been acclimated since the dawn of civilization. Though it is not practical to go to bed with the sun, it does make sense to get up with it, and this provides us with a good excuse not to stay up to all hours and become sleep-deprived. Not getting sufficient high-quality sleep has been linked to increased appetite and unwanted weight gain.


(FOR  MOST  YOUNGER  PEOPLE  UNDER  AGE  55  GOING  TO  BED  BEFORE  MIDNIGHT  SHOULD  IN  NORMAL  CIRCUSTANCES  BE  REGULAR [AS  I  WAS  WHEN  UNDER  AGE  55]  -  HENCE  A  GOOD  8  HOURS  SLEEP  SHOULD  BE  AIMED  FOR.  NOW  INTO  MY  60s  AND  70s  MY  BODY  RYTHM  HAS  CHANGED  -  I'M  NOW  A  "NIGHT  OWL"  -  SELDOM  GOING  TO  BED  BEFORE  2  AM.  I  HAVE  NO  "MORNING  JOB"  90  PERCENT  OF  THE  TIME,  AND  SO  I  CAN  SLEEP  TILL  10  AM  OR  AFTER.  I  FIND  THIS  HAS  NOT  GIVEN  ME  ANY  TROUBLE  IN  MY  OVERALL  EXCELLENT  HEALTH,  AS  I  WATCH  WHAT  I  EAT  AND  GET  REGULAR  EXERCISE,  IN  MANY  DIFFERENT  WAYS  -  Keith Hunt)


Sleep to Lose Weight


An important study at the University of Chicago demonstrated that sleep deprivation causes us to overeat, because it disrupts the balance between two appetite-related hormones—ghrelin and leptin. When we don't get enough sleep, our levels of ghrelin, a hormone produced by stomach cells and believed to increase feelings of hunger, rise. Leptin, a hormone produced by our fat cells that suppresses appetite and burns fat stores, is decreased.


Even worse, the most sleep-deprived people in the study craved fattening, carbohydrate-rich foods, such as cookies, cake, candy, pasta, and muffins. According to Dr. Eve Van Cauter, the lead researcher, these cravings are the result of elevated levels of the stress hormone Cortisol. When we are fully rested, our Cortisol levels drop; sleep deprivation has the unfortunate opposite effect. The study participants also metabolized glucose less efficiently. Dr. Van Cauter reported that the effects of sleep deprivation on glucose metabolism are similar to those found in the elderly. She therefore concluded that chronic sleep deprivation may have long-term harmful effects on the body—not the least of which are weight gain and possibly accelerated aging as well.


(IT  IS  INDEED  VERY  IMPORTANT  TO  MAINTAIN  A  REGULAR  8  HOURS  OR  SO  OF  SLEEP  EACH  DAY  -  Keith Hunt)


As with exercising, we need to establish regular, healthy habits and regimens. We should strive to get close to eight hours of sleep per night and learn not to skip meals, including breakfast. Implementing these simple rules will eliminate the pro-inflammatory habits we tend to fall into and help us achieve and maintain optimum weight.

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I was determined to help these individuals lose weight rapidly in a healthy manner yet not sacrifice the health benefits of my traditional anti-inflammatory diet. I was confident that by taking the anti-inflammatory approach, my patients could successfully preserve muscle tissue and bone while metabolizing body fat.

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Obesity has traditionally been defined as a weight at least 20 percent above the ideal weight corresponding to the lowest death rate for individuals of a specific height, gender, and age. A weight of 20 to 40 percent over ideal weight is considered mildly obese; 40 to 100 percent over ideal weight is considered moderately obese; and 100 percent over ideal weight is considered severely, or morbidly, obese.

The BMI (Body Mass Index)


Another way to determine healthy weight is via the body mass index (BMI). This number is calculated from a person's weight and height. BMI, as defined by the Centers for Disease Control and Prevention, is a fairly reliable indicator of body fat for most people. BMI does not measure body fat directly, but research has shown that it correlates well with direct measures of body fat, such as underwater weighing and dual-energy X-ray absorptiometry.


To calculate your BMI, see the directions at www.nhlbisupport .com/bmi.



Weight, and sugar addiction. "When rats are drinking high-fructose corn syrup at levels well below those in soda pop, they're becoming obese—every single one, across the board. Even when rats are fed a high-fat diet, you don't see this; they don't all gain extra weight.


The rats drinking HFCS in the Princeton study became obese and those drinking sugar water did not. In a classic example of gene expression, it appears that the fructose activated the genes that store fat, while the sucrose activated the genes that either process the glucose for energy or store it as a carbohydrate known as glycogen in the liver and muscles.


Tricking the Brain into Overeating


When we consume such simple sugars as HFCS, we cause an immediate pro-inflammatory spike in our blood sugar. Unlike glucose, however, fructose does not stimulate the secretion of insulin or enhance the production of leptin—key hormones that regulate the appetite. Since insulin and leptin act as signals to the brain for the regulation of food intake and body weight, the ability of fructose to circumvent these mechanisms may contribute to overeating. This completely upsets the body's natural balance. Fructose bypasses the natural mechanisms that prevent overeating and tricks the body into thinking it is still hungry— even after consuming a large meal—making it a fast-food marketer's dream! No wonder they supersize the sodas! (And those who drink them.)


(MANY  EATING  PLACES  SAY  YOU  CAN  HAVE  A  RE-FILL  ON  THE  SODA  POPS….. NOT  AS  GENEROUS  AS  YOU  THINK;  THERE  IS  THE  UNDERLYING  REASON  WE  HAVE  JUST  SEEN  FOR  SUPER-SIZING  THE  SODAS  -  Keith Hunt)


The reason for this is the difference between the digestive and absorptive processes for glucose and fructose. When we consume large amounts of fructose, which is basically an unregulated source of fuel for the liver, it is converted to both fat and cholesterol. As my readers know, I am no advocate of sugar—in fact, sugar is toxic—but the effects of fructose, particularly in the form of high-fructose corn syrup, are an even more significant cause for alarm. I am not talking about the narually occurring fructose found in fresh fruit. Eating fresh fruit provides us with many nutrients, minerals, enzymes, and phytochemicals, and is highly recommended.


The Metabolic Miracle Meal Replacement


Kelly, whose high-profile lifestyle and livelihood underscored the importance of looking good, was a perfect candidate for the Metabolic Miracle diet. For breakfast and lunch, she had the Metabolic Miracle Meal Replacement Drink and the recommended supplements. For dinner she had a piece of fresh fish—salmon as often as possible—or a boneless, skinless chicken breast sauteed lightly in olive oil and served on a bed of cooked lentils, together with a salad made of watercress and dressed with extra-virgin olive oil and fresh lemon juice and a cup of steamed veggies, such as broccoli or cauliflower. I also recommended that she drink a lot of green tea, which contains a very special catechin, EGCG, that accelerates weight loss and helps block fat absorption.


We must eat fat to burn fat, which means that cold-water fish, chia seeds, extra-virgin coconut oil, and olive oil all help us burn fat. 


The pro-inflammatory sugary, starchy foods are just the opposite. Because they raise insulin and blood sugar levels, they put an actual "lock" on fat burning. The Metabolic Miracle Meal Replacement, the supplements, and the recommended dinner menu consist of foods with potent anti-inflammatory properties as well as highly bioavailable nutrients that protected Kelly's muscle and bone while she rapidly metabolized body fat, ensuring that her weight loss would be rapid.


Within weeks, Kelly had lost 25 pounds and 5 inches from her waistline. "Dr. Perricone, I am going to stay on this forever!" she vowed enthusiastically at a follow-up meeting six weeks later. Eventually she would introduce more foods into her diet, but she planned to maintain the Metabolic Miracle Meal Replacement drink for breakfast, as it kept her energized and filled with a sense of well-being for hours. Kelly also intended to take the supplements on a regular basis, because they improved both her physical and mental well-being.


The high-quality protein in the Metabolic Miracle Meal Replacement drink is vital to cellular repair, and the metabolic supplements are critical to the suppression of appetite. This protein, as well as the omega-3 essential fats, will ensure that your skin will be radiant and glowing as the unwanted body fat melts away. For Kelly, whose face is her fortune, the results were superb—she looked years younger, with a luminous complexion to match her new lithe, slim, and toned figure.


Wini told me that Kelly was a wonderful yoga student, eager to learn and making rapid progress. Like nutrigenomics and the metabolic miracle, yoga is all about self-empowerment. As with nutrigenomics and the metabolic miracle, visible results are seen in a very short time, which helps to keep Kelly's enthusiasm and motivation at optimal levels.


I know the Metabolic Miracle diet plan will help you to take control of your weight and consequently your health. Being chronically overweight stresses our bodies and will age us prematurely. Following my program will help you to maintain a lean body at a healthy weight, increase your energy, and conquer your food cravings. You will lose weight without that haggard, dried-out, pale, and exhausted look. Instead, you will be radiant, fresh, and youthful in body and spirit.

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DR.  PERRICONE   DOES  NOT  GET  INTO  EXERCISE  IN  THIS  CHAPTER,  BUT  ELSEWHERE  HE  DOES.  THE  IMPORTANCE  OF  GOOD  PHYSICAL  EXERCISE  CANNOT  BE  OVERSTATED.  SOME  OF  THAT  EXERCISE  SHOULD  CONTAIN  GETTING  THE  HEART  PUMPING  AWAY -  HENCE  FAST  SWIMMING,  OR  FAST  STILL  BIKE  WORKOUT [AS  FAST  AS  YOU   CAN  GO  FOR  30  SECONDS,  THEN  90  SECONDS  REST;  REPEAT  5  OR  6  TIMES].  ALSO  GET  SOME  WEIGHTS  [THE  QUICK  ADJUSTABLE  WEIGHT  ONES]  -  BAR-BELLS,  AND  WORK  WITH  THEM  FOR  15  MINUTES  3  TIMES  A  WEEK  -  AGAIN  GETS  THE  HEART  PUMPING.  THEN  THERE  IS  FAST  WALKING;  AND  ALSO  SOME  GOOD  OLD  CHARLES  ATLAS  DYNAMIC  TENSION  EXERCISES  FROM  HIS  "HEALTH  AND  STRENGTH  COURSE" [STILL  AVAILABLE].


Keith Hunt