Category: Nutrition

  • How to use fitness trackers to enhance performance and wellbeing—without losing touch with yourself

    How to use fitness trackers to enhance performance and wellbeing—without losing touch with yourself

    While our ancestors relied on their senses to assess how they were doing, increasingly, we rely on gadgets.

    Today, if you’re curious enough, you can measure your heart rate, your step count, your exercise intensity, and your sleep quality—sometimes all on one sleek device.

    In the best cases, these devices offer a bridge between what you subjectively feel and what you can objectively measure.

    This is generally a really cool and amazing thing.

    Our subjective feelings and assessments matter, but they’re not always the most reliable. Us humans just aren’t particularly skilled at quantifying our experiences and behaviors with cold precision.

    Take, for example, a colleague of mine. He believed he was eating within a narrow caloric window, but after careful tracking, he learned that he was putting away a bonus 500 Calories a day—in barbecue sauce.

    That said, some of us are better than others.

    Ben Johnson, the Canadian sprinter, was reported to have been able to call out his 100 metre time within a tenth of a second of the stopwatch readout.1

    That’s outlier performance, to be clear, but it still makes you wonder:

    How good are you at assessing yourself?

    And, how can you improve your accuracy through the wise use of technology—like fitness trackers—to help you make better decisions about your health?

    In the following article, we’ll tackle the above, plus we’ll address:

    • How accurate are data trackers in the first place?
    • When is tracking helpful? (And when is it not?)
    • Can you train yourself to more accurately assess things by feel?

    Let’s get into it.

    First, how accurate are data trackers anyway?

    Not all data is created equal.

    Some brands produce better products than others. This is not just hardware but also the quality of their software and datasets.

    Beyond that, not all things are equally easy to quantity.

    For example, heart rate and step-count data are generally reliable,2 but many other types of outputs—from calories burned to movement velocity—have substantial margins for error.

    The below chart shows the reliability of various tracking devices.An infographic chart titled 'Tracking Devices and the Health Metrics They Can Assess' comparing different devices (Pedometers, Activity Bands, Smartwatches, Chest Straps, Ring Trackers, Smartphone Apps, Medical Wearables, and Strength Wearables) against various metrics (Steps, Heart Rate, Recovery, Calories, Sleep Duration, Sleep Quality, Speed, and Power). The accuracy is indicated by green checkmarks (very accurate), yellow dots (decent accuracy), and red X's (limited or not available).

    (If you’re curious, we cover the accuracy of various progress indicators in more detail here: Are Fitness Trackers Worth It?)

    Next, when is tracking actually helpful?

    The good: Tracking devices offer us more data about our behaviors and bodies than ever before.

    The bad: Tracking devices offer us more data about our behaviors and bodies than ever before.

    “What’s really remarkable,” says Samantha Kleinberg, a computer scientist who studies decision-making, “is that even a tiny amount of surplus information has a big negative effect on our decision-making.”3

    That’s the paradox of tracking: Too little detail makes it tough to make the right decision, but so does too much. A graph showing 'The Effect of Information on Decision Making' with an inverted U-shaped curve. The x-axis shows 'Amount of relevant information available' and the y-axis shows 'Ability to make decisions'. The peak of the curve is labeled 'Sweet spot', suggesting an optimal amount of information for decision-making, with performance declining when there's either too little or too much information.

    This can be expressed as an inverted U, with the sweet spot at the top of the curve.

    Today, it’s surprisingly easy to have too much information.

    Consider the analysis paralysis you feel after scanning hundreds of reviews from the various taco places in your neighborhood. (All you wanted was a decent el pastor, but now you don’t know which taqueria to pick!)

    Finding just enough information to make good decisions is an art form—especially in the world of health and fitness, where it seems like everyone is trying to outdo each other when it comes to providing more science, more customization, and more complexity.

    But when all that information starts to blur together with no clear path forward, what should you do?

    For starters, you can ask yourself a simple question:

    Does tracking increase my wellbeing and performance?

    If the answer is a clear yes or no, you know what to do. (Either continue tracking as you were, or drop the gadget and walk away.)

    If you’re a little fuzzy, here are three signs to watch for to help you determine if tracking is helpful—or not.

    Sign #1: Tracking is decreasing your stress and validating your method(s).

    When Zak’s coach raved about the benefits of zone 2 cardio, it sounded logical. But when the rubber on his running shoes hit the road, Zak second-guessed everything. Zak prided himself on his ability to grind, and simply didn’t trust that something that felt easy could also be effective.

    Yet, the data didn’t lie. As the weeks went by, Zak watched his resting heart rate drop—along with his recovery time from hard runs. With that reassurance, Zak began to relax about the process—and his resting heart rate dropped further.

    Zak hadn’t trusted his feelings, but he did trust the data from his heart rate monitor.

    Using a tracking device enabled Zak to calibrate his own perceptions so they were more accurate and realistic.

    If you’re a coach who has a client like Zak who’s high performing but doesn’t know it, tracking can help build confidence and reduce the anxiety that they’re “not good enough.”

    Here, you empower them by shining a spotlight on existing performance. Expert assurance can go a long way but can also be bolstered by reliable data.

    (Recently, many people have begun using continuous glucose monitors, or CGMs, in order to “optimize” their blood sugar levels. This can help “validate” certain food choices… but it can also be a waste of time. Read more: Should people without diabetes use CGMs?)

    Bad omen: Tracking is increasing stress or negatively affecting performance.

    Sometimes, data can stress you out without any upside—like when you receive poor scores about things beyond your control.

    Take the new parent of a newborn who gets a poor sleep quality score.

    Tracking has a time and a place. When scores are beyond your control or your priorities lie elsewhere, tracking can create unnecessary stress and is counterproductive.

    You can always revisit tracking when circumstances or priorities change.

    Sign #2: Clear feedback from data is enhancing your motivation and ability.

    For a behaviour to take place, you need three things4:

    • Motivation: A compelling reason or desire to take action toward achieving something. This can come from external sources (your spouse is urging you to quit smoking) or internal drives (you’ve always dreamed of running a marathon).
    • Ability: You have a combination of skills, plus opportunities to express them. (For example, you know how to do a simple resistance training routine, and you have 20 minutes a day to execute it.) This may involve overcoming constraints like time, money, mental and/or physical effort, social pressures, and changes to routine.5
    • Prompt: A prompt is a cue or instruction that elicits an action. (For example, when your GPS tells you to turn left, or when your restless legs “remind” you you’re due for a walk.) Critically, even with high levels of motivation and ability, you may not take action—or the right kind of action—without a prompt.

    Fitness trackers shine when you’ve got plenty of motivation and ability—and just lack the prompt.

    Take my client, Margaret. She used to have a glass of wine most nights, believing it helped her sleep better. Once she started wearing a sleep tracker though, she saw that her sleep quality was much poorer the nights she imbibed. Once she received this prompt—her sleep score—she adjusted her behavior.

    When you highlight important data, the right choices become clearer.

    When it comes to changing behaviours, sometimes all it takes is one key piece of data. As they say, “Once you see it, you can’t un-see it.”

    (PN’s CEO Tim Jones used the feedback he got from various lifestyle trackers to finally reduce his genetically high cholesterol levels—and built a richer, more meaningful life in the process. Read more: How This Guy Cut His Cholesterol in Half Without Drugs)

    Bad omen: Data collection is decreasing motivation or ability.

    When Jan, an avid recreational cyclist, found out he could view—then demolish—the records set on local biking trails, he set to work. But as those records were destroyed, so too was his ability to ride for enjoyment. His focus on speed left him under-recovered and eventually led to burnout.

    If workouts have become more about the numbers and less about technique, experience, or even enjoyment, tracking is likely no longer helpful.

    Sign #3: Tracking is helping you understand yourself better.

    The harder you work, the better your results.

    Right?

    Not necessarily.

    This belief tends to get grinders like Zak into trouble because they think they’re making progress—but really they’re just getting in their own way, even inhibiting performance and recovery.

    Meanwhile, there are also many people who chronically underestimate their effort and capacity, and would benefit from turning up the heat. Here, data can help us more accurately understand our own potential.

    Let’s look at high-intensity interval training (HIIT) as an example. HIIT workouts alternate fixed periods of intense effort with fixed periods of rest. However, these fixed periods of rest are just estimates of recovery times.

    Heart rate data can create a more individualized picture of actual recovery needs, which may be faster or slower than you expect.

    Sometimes, the mind says yes but the heart says not quite yet.

    A good coach does more than just simply ask for more. They also help keep clients out of the unproductive “junk volume” zone, where fatigue accumulates but performance doesn’t improve (and maybe even worsens).

    By looking at real-time metrics of output, fatigue, and recovery, you can better understand yourself and your clients, and help keep everyone training and recovering efficiently.

    Bad omen: Over-reliance on data is making you lose touch with your own senses.

    When you become overly reliant on data, you risk losing touch with your own sense of how you feel, whether that’s hunger and fullness levels, energy and fatigue, or something else.

    A relevant example is “The Great My Fitness Pal Blackout.”

    In January of 2019, the calorie-tracking app (with a reported 200 million subscribers!) went down for a day. Pretty minor—unless you happened to be tracking your macro and caloric intake and waiting for the app to tell you exactly how much you could eat that day… which I was.

    When the app wouldn’t load, I recognized the mild panic I felt was unhelpful. My overreliance on the app had disconnected me from my own internal signals, and without it, I felt adrift. Since then, I’ve shifted my focus to how energetic I feel and one of the oldest tracking technologies available: the mirror.

    (If you feel like you’re lost without your besties—your phone and your apps—there’s a name for that. There are also ways to develop a healthier relationship with your tech. Read more: What is nomophobia?)

    3 ways to use fitness trackers to help you make more accurate self-assessments

    Before we get to how to do the above, let’s talk about why assessing things by feel can be so important.

    Whether it’s body fat percentage or movement speed, even supremely motivated and capable clients will experience diminishing objective results from their training.

    The scale stops dropping, the number of plates you’re able to load on the bar plateaus, or—gasp—your race time even regresses.

    Motivation based purely on progress or other extrinsic goals6 will fall away during these times.

    However, exercisers who focus on feelings of mindfulness7, mastery, meaning8, and success9 develop a more resilient practice. They also enjoy the process more, whether that’s the process of running, lifting, winding down for a good night’s sleep, or just enjoying a meal.

    So, although objective data can provide essential feedback and guidance, you’ll only reap the full benefits of your practice—that is, enjoyment and results—if you maintain connection with your felt experience.

    And good news: You can actually use fitness trackers to calibrate and even improve your ability to accurately sense what’s happening in your body.

    Here are three ways to do it.

    1. Check in with yourself before you check the data.

    Can you imagine asking someone how their vacation was and then waiting for them to look at their photos to be able to answer? That’s what it’s like when you rely purely on external data about your own experience.

    Whatever the metric—how far you biked, how many calories you consumed, or how fast your heart was beating—the simplest way to work mindfully with tracker data is to pause, breathe, and then tune into the powerful (if not always accurate) prediction-making powers of your brain.

    Once you’ve checked in with yourself, you can calibrate your self-assessment by comparing the detailed (if not always accurate) outputs of your fitness tracker.

    Over time, you may be able to narrow the gap between two.

    (Note: Don’t forget to regularly update your app. Algorithms and data sets are regularly adjusted for better predictive accuracy.)

    2. Develop mental shortcuts that can occasionally stand in for objective measures.

    The coaches I work with regularly ask people to estimate the boundaries of their strength (such as how many reps they can do at a given weight until failure).

    Novices are often terrible at estimating this—and regularly off the mark by five or more reps. However, the use of objective trackers can help calibrate their understanding, and most people can reduce their margin of error dramatically.

    In theory, you might use fancy tools like accelerometers or blood lactate measurements, but our coaches just ask, “For a million dollars a rep, how many more reps do you think you could do?”

    Though there’s nothing objective about this question, most clients are able to use the prompt as a kind of shortcut to understand maximal effort. (After all, that last rep may be worth seven figures!)

    The question also leverages the rate of perceived exertion (RPE)—your perception of how hard you’re working—which is one of the most validated sensory-driven approaches.

    Not everyone is automatically good at estimating RPE, but most people can improve their skills by mapping their felt experience with occasional calibration with objective data.

    3. Keep developing your ability to dial into your senses.

    Trackers have components like accelerometers, GPS, and gyroscopes to sense data about speed, distance, and more.

    But humans are no slouches either.

    We have…

    • Mechanoreceptors that respond to pressure, vibration, and the joint angles change
    • A vestibular system that monitors balance and angle changes
    • Proprioceptors that clock the speed and rate of length-change of muscle spindles
    • Thermoreceptors that register register warming or cooling
    • Chemoreceptors that detect chemical changes, such as scent or taste, as well as changes in the bloodstream
    • Nociceptors—part of the body’s alarm system—that sense threat and send signals of potential harm or distress

    And that’s only a partial list.

    You have access to an incredibly rich network of sensory information—something that technology cannot begin to touch.

    All of this information is fed into the powerful pattern-recognition machine of your nervous system.

    To continue honing your ability to use this rich network of sensory information, regularly check in with what and how you’re feeling.

    When you learn to calibrate your own senses with objective data, you can leverage all the cool advances in wearable tech—while still keeping your own experience front and centre.

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    References

    Click here to view the information sources referenced in this article.

    1. Francis C. Speed Trap: Inside the Biggest Scandal in Olympic History. Toronto: Stoddart Publishing Co. Ltd.; 1990.
    2. Stat News. Fitbit’s accuracy has a dark-skin problem. Stat News [Internet]. 2019 Jul 24 [cited 2024 Nov 23]. Available from: https://web.archive.org/web/20240129224809/https://www.statnews.com/2019/07/24/fitbit-accuracy-dark-skin/
    3. Stevens Institute of Technology. Want to make better decisions? Ask for less information, not more. Stevens Institute of Technology [Internet]. 2023 [cited 2024 Nov 23]. Available from: https://www.stevens.edu/news/want-to-make-better-decisions-ask-for-less-information-not-more
    4. Fogg B. Behavior Model. BehaviorModel.org [Internet]. 2024 [cited 2024 Nov 23]. Available from: https://behaviormodel.org/
    5. Fogg, B. J. 2019. Tiny Habits: Small Changes Change Everything. New York; Houghton Mifflin Harcourt.
    6. Bradshaw, Emma L., James H. Conigrave, Ben A. Steward, Kelly A. Ferber, Philip D. Parker, and Richard M. Ryan. 2023. A Meta-Analysis of the Dark Side of the American Dream: Evidence for the Universal Wellness Costs of Prioritizing Extrinsic over Intrinsic Goals. Journal of Personality and Social Psychology 124 (4): 873–99.
    7. Hagan, John E., Jr, Dietmar Pollmann, and Thomas Schack. 2017. Elite Athletes’ in-Event Competitive Anxiety Responses and Psychological Skills Usage under Differing Conditions. Frontiers in Psychology 8 (December). https://doi.org/10.3389/fpsyg.2017.02280.
    8. University of Rochester Medical Center. Self-Determination Theory [Internet]. Rochester (NY): University of Rochester Medical Center; [cited 2024 Nov 25]. Available from: https://www.urmc.rochester.edu/community-health/patient-care/self-determination-theory.aspx
    9. Teixeira DS, Bastos V, Andrade AJ, Palmeira AL, Ekkekakis P. Individualized pleasure-oriented exercise sessions, exercise frequency, and affective outcomes: a pragmatic randomized controlled trial. Int J Behav Nutr Phys Act. 2024;21(1):1636.

    If you’re a coach, or you want to be…

    You can help people build sustainable nutrition and lifestyle habits that will significantly improve their physical and mental health—while you make a great living doing what you love. We’ll show you how.

    If you’d like to learn more, consider the PN Level 1 Nutrition Coaching Certification. (You can enroll now at a big discount.)

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  • Dietitians Unite 2025 Exclusive Cocktail Party

    Dietitians Unite 2025 Exclusive Cocktail Party

     

    After a day of professional development, join us at Chin Chin to network, unwind and bask in the buzz of an incredible day.

    Think: drinks, delicious canapés AND an invaluable opportunity to connect with leading professionals in the nutrition and dietetics field.

    But get in quick! Cocktail party tickets are strictly limited to just 50, and sales close at 5pm on Friday 14th March. We can’t wait to see you there!

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  • Exploring the Obesity Paradox 

    Exploring the Obesity Paradox 

    How do we explain studies that suggest overweight individuals live longer?

    Martin Luther King Jr. warned that human progress is neither automatic nor inevitable, and the same may be true of the human lifespan. In the 1800s, life expectancy was less than 40 years, but it has been “advancing steadily” over the last two centuries, “increasing at approximately 2 years per decade”—until recently. Longevity gains appear “to be faltering or even being reversed.” Thanks to the obesity epidemic, we may now be raising the first generation to live shorter lives than their parents.

    “This downward trend in longevity will almost certainly accelerate as the current generation of children—with higher body weights from earlier in life than ever before—reaches adulthood.” Current trends “potentially signal a looming social and economic catastrophe” if the obesity epidemic continues unchecked. In the coming decades, some predict we may lose two to five years or more of life expectancy in the United States. To put that into perspective, a miracle cure for all forms of cancer would only add three and a half years to the average U.S. life expectancy. In other words, reversing the obesity epidemic might save more lives than curing cancer.

    The evidence that being overweight increases our risk for debilitating diseases like diabetes is considered “indisputable.” However, surprisingly, there is controversy surrounding body weight and overall mortality. In 2013, scientists with the Centers for Disease Control and Prevention (CDC) published a meta-analysis in the Journal of the American Medical Association suggesting that being overweight was advantageous. Grades 2 and 3 obesity, such as being an average height of 5’6″ and weighing about 216 pounds (98 kg) or more, were associated with living a shorter life, but grade 1 obesity, weighing about 185 to 215 pounds (84 to 97 kg) at that height, was not. Being overweight (about 155 to 185 pounds/70 to 83 kg at 5’6″) appeared to be protective compared to those who were a “normal weight” of 115 to 155 pounds (52 to 69 kg). The overweight individuals, those with a body mass index (BMI) of 25 to 30, appeared to live the longest.

    Headline writers were giddy. “Being overweight can extend your life rather than shorten it,” read one. “Dreading your diet? Don’t worry—plump people live LONGER than their skinnier counterparts…” read another. “Extra pounds mean a lower chance of death.” Not surprisingly, the study ignited a firestorm of controversy in the public health community. The study was called “ludicrous,” “flawed,” and “misleading.” The chair of nutrition at Harvard lost his cool, calling the study “really a pile of rubbish” and fearing the food industry might exploit the study in the same way the petroleum industry misuses “controversy” over climate change. 

    Public health advocates can’t just dismiss data they find inconvenient, though. Science is science. But how could being overweight increase the risk of life-threatening diseases, yet, at the same time, make you live longer? This became known as “The Obesity Paradox,” the subject of my video Is the Obesity Paradox Real or a Myth?.

    The solution to the puzzle appears to lie with two major sources of bias, the first being “confounding by smoking.” The nicotine in tobacco can lead to weight loss. So, if you’re skinnier because you smoke, then no wonder you’d live a shorter life, albeit with a slimmer waist. The failure to control for the effect of smoking in studies purporting to show an “obesity paradox” leads to the dangers of obesity being “grossly underestimated.”

    The second major source of bias is reverse causality. Instead of lower weight leading to life-threatening diseases, isn’t it more likely that life-threatening diseases lead to lower weight? Conditions such as hidden tumors, chronic heart or lung disease, alcoholism, and depression can all cause unintentional weight loss for months or even years before they are even diagnosed. It’s normal to be overweight in the United States, for example. So, people who are “abnormally” thin—in other words, at an ideal weight—may be taking care of themselves, but they may instead be “heavy smokers, frail and elderly, and seriously ill with weight loss due to their disease…” 

    To put the obesity paradox to the test once and for all, The Global BMI Mortality Collaboration was formed, reviewing data from more than 10 million people from hundreds of studies in dozens of countries—the largest evaluation of BMI and mortality in history. To help eliminate bias, the researchers omitted smokers and those with known chronic disease, then excluded the first five years of follow-up to try to remove from the analysis those with undiagnosed conditions who lost weight due to an impending death. And? The results were clear: “This analysis has shown that both overweight and obesity (all grades) were associated with increased all-cause mortality”—a greater risk of dying prematurely. So, “adjusting for these biases leads to eliminating the obesity paradox.” In other words, the so-called obesity paradox appears to be “just a myth.”

    Indeed, when intentional weight loss is put to the test, people live longer. There are bariatric surgery studies like the SOS trial that show that weight loss reduces long-term mortality, and randomizing study participants to weight loss through lifestyle changes shows the same thing. Losing a dozen pounds through diet and exercise was found to be associated with a 15 percent drop in overall mortality. Now, exercise alone may extend lifespan even without weight loss, but there appears to be a similar longevity benefit of weight loss through dietary means alone.

    If you missed the previous blog posts in my series on the ABCs of obesity, see:

    Check out the final two videos in this series: What’s the Ideal BMI? and What’s the Ideal Waist Size?.

    I cover all of this and more at length in my book How Not to Diet, and its companion, The How Not to Diet Cookbook, has more than 100 delicious Green-Light recipes that incorporate some of my 21 Tweaks for the acceleration of body fat loss.

    Why are people obese in the first place? I have a whole series of videos on that topic. Check the videos in the related posts.



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  • Obesity’s Impacts on Our Immune System and Kidney and Liver Diseases 

    Obesity’s Impacts on Our Immune System and Kidney and Liver Diseases 

    What are the effects of weight loss on natural killer cell function, our first line of immune defense against cancer, kidney function, and fatty liver disease?

    In the ABCs of the health consequences of obesity, I is for Immunity.

    The SOS trial followed the fates of thousands of bariatric surgery patients for a decade or two, compared to a control group who maintained their weight. Those who surgically lost about 20 percent of their body weight not only lived longer, thanks in part to less diabetes and less cardiovascular disease, but they also got less cancer. This may be because anti-tumor immunity appears to be affected by weight.

    Natural killer cells are our immune system’s first line of defense against cancer cells and many viral infections, “and their function is severely impaired in individuals with obesity.” When individuals who were obese were randomized to a weight-loss program, researchers found a significant reactivation of the participants’ natural killer cell function within just three months. The program involved an exercise component, though, so it’s hard to tease out the impact of the weight loss itself since physical activity on its own can boost natural killer cell activity.

    On the other end of the immune spectrum, obesity is suspected to be a causal risk factor for the development of the autoimmune disease multiple sclerosis. This suggests obesity is associated with the worst of both worlds when it comes to immune function: underactivity when it comes to protecting against cancer and infection, and overactivity when it comes to certain inflammatory autoimmune conditions.

    J is for Jaundice. Thanks to the obesity epidemic, nonalcoholic fatty liver disease is now the most common liver disorder in the industrialized world. Fat doesn’t just end up in our belly and thighs but inside some of our internal organs. More than 80 percent of individuals with abdominal obesity may have fatty infiltration into their liver, and in those with severe obesity, the prevalence can exceed 90 percent. This can lead to inflammation, scarring, and, ultimately, cirrhosis and liver cancer, as you can see below and a 2:10 in my video The Effects of Obesity on the Immune System and Kidney and Liver Diseases. Currently, this nonalcoholic fatty hepatitis is the leading cause of liver transplants in American women. 

    K is for Kidneys. Obesity is also “one of the strongest risk factors for new-onset chronic kidney disease.” Our kidneys compensate for the metabolic demands of excess weight by red-lining into what’s called “hyperfiltration” to deal with the extra workload. This resulting increased pressure within our kidneys can damage the sensitive structures and increase the risk of kidney failure over the long term.

    What about L, M, N, O, P through Z? If you want to continue through the alphabet, L could be for diminished lung function, M could be for metabolic syndrome, and so on. There is even an X—for xiphodynia—pain at the tip of the bottom of the breastbone from being bent forward by an expanding abdomen.

    Given the myriad health conditions associated with excess weight, “annual medical spending attributable to an obese individual” is nearly $2,000 per year and workers who are obese with multiple conditions can cost companies up to $10,000 more in healthcare coverage compared to “their lean counterpart.” This may account for some of the wage gap that employees who are obese may experience, as companies try to pass along these costs of “their higher health insurance premiums,” beyond just brazen discrimination. Between healthcare costs and diminished productivity in terms of lost workdays, the total lifetime costs of obesity for children and teens have been estimated to exceed $150,000.

    Some estimates peg the annual “medical care costs of obesity in the United States” at about $150 billion, with another $50 billion per year added by 2030 as our increasingly heavy Baby Boomers continue to age. Others diametrically disagree, based on the morbid fact that individuals who are obese may not live as long. Just as “the high medical costs of smoking-related diseases are more than offset by lower survival of smokers,” the lifetime healthcare costs of individuals who are obese may turn out to be lower because they are expected to die so much sooner. So, the true cost may be more in lives, rather than dollars. How much does being overweight cut your life short? I’ll explore just that question next.

    If you missed the previous blog posts in my series on the ABCs of obesity, see related posts below.

    I continue the topic of obesity and weight with these videos: Is the Obesity Paradox Real or a Myth? and Friday Favorites: What’s the Ideal BMI and Waist Size?.

    For more on the health conditions discussed in this video, see the immune function, kidney disease, and liver health topic pages. 



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  • Obesity’s Impacts on Gallstones, Acid Reflux, and Heart Disease 

    Obesity’s Impacts on Gallstones, Acid Reflux, and Heart Disease 

    Sufficient, sustained weight loss may cut the risk of fatal heart attacks and strokes in half.

    In the ABCs of health consequences of obesity, G is for Gallstones.

    The top digestive reason people are hospitalized is a gallbladder attack. Every year, more than a million Americans are diagnosed with gallstones, and about 700,000 must have their gallbladders surgically removed. It is a relatively safe procedure, with complication rates tending to be under 5 percent and a mortality rate of only about 1 in 1,000. However one in ten may develop a post-cholecystectomy syndrome of persistent gastrointestinal symptoms long after their gallbladder is removed.

    What are gallstones made of? In 80 to 90 percent of cases, gallstones are mostly crystalized cholesterol, forming like rock candy in our gallbladder when cholesterol gets too concentrated. This was used to explain why some small, early studies found that non-vegetarians had a higher incidence of gallstones. However, results from more recent, larger studies are more equivocal; one study suggests that a “vegetarian diet may therefore protect” against gallbladder disease, for instance, while another shows higher rates among vegetarians, independent of weight.

    As I discuss in my video The Effects of Obesity on Gallstones, Acid Reflux, and Cardiovascular Disease, the biggest purported cause-and-effect risk factor may be obesity, increasing risk as much as sevenfold, as you can see below and at 1:32 in my video, with a doubling of risk even at the heavier side of “the normal BMI range.” 

    Ironically, rapid weight loss may also be a trigger. Half a pound (1.5 kg) a day has been deemed the upper limit for medically safe weight loss, based on gallstone formation. Ultrasound studies found that, above that, the chance of new gallstones can go from less than 1 in 200 a week to closer to 1 in 40, as shown below and at 1:59.

    To help prevent a gallstone attack, we can increase our fiber intake. Not only is dietary fiber intake associated with less gallbladder disease in the first place, but those placed on high-fiber foods during a weight-loss regimen suffered significantly less gallbladder sludging than those losing the same amount of weight without getting the extra fiber.

    G is also for gastroesophageal reflux disease, or GERD. Fiber-rich food consumption decreases the risk of acid reflux, too. I previously explored how chronically straining at stool may push part of the stomach up into the chest cavity. Well, excess abdominal pressure due to obesity may have the same effect, pushing acid up into the throat and causing heartburn and inflammation. The increased pressure on the abdominal organs associated with obesity may also explain why overweight women suffer from more vaginal prolapse, where organs such as the rectum push out and into the vaginal cavity. 

    The deadliest letter in the alphabet of obesity consequences is H, which is for Heart Disease. Of the four million deaths attributed to excess body weight every year around the world, nearly 70 percent are due to cardiovascular disease. Is it just because of eating poorly? Mendelian randomization studies suggest that people randomized from conception to be heavier—based only on genetics—do indeed have higher rates of heart disease and stroke regardless of what they eat. The question is: If you lose weight, does your risk drop?

    Enter the Swedish Obese Subjects (SOS) trial, the first long-term controlled trial to compare the outcomes of thousands of bariatric surgery patients to matched control subjects who started out at the same weight but went the nonsurgical route. Individuals in the control group maintained their weight, whereas those in the surgical group maintained about a 20 percent weight loss over the next 10 to 20 years. In that period, those in the weight-loss group not only developed 80 percent less diabetes, but they suffered significantly fewer heart attacks and strokes. So, unsurprisingly, they significantly reduced their total mortality overall. Ten years out, the weight-loss group appeared to cut their risk of fatal heart attacks and strokes in half, as shown below and at 4:23 in my video

    If you missed the previous videos in my series on the ABCs of obesity, see:

    I continue the topic of obesity and weight with videos in the related posts below.

    For more on the health conditions discussed in this video, see the gallstones, GERD, and heart disease topic pages.

    The GERD-related video I mentioned is Diet and Hiatal Hernia



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  • Obesity’s Impacts on Our Brain, Dementia, and Fertility 

    Obesity’s Impacts on Our Brain, Dementia, and Fertility 

    Weight loss can decrease dementia risk and improve mental performance and fertility.

    As I’ve discussed previously, in the ABCs of the health consequences of obesity, A is for Arthritis, B is for Back Pain and Blood Pressure, C is for Cancer, and D is for Diabetes. That brings us to E, which is for Encephalopathy.

    Encephalopathy means brain disease. There are consistent data linking obesity in middle age to a higher risk of dementia later in life. Researchers found that individuals who are overweight have about a one-third higher risk of dementia and those who are obese in mid-life have about 90 percent greater risk. The risk isn’t limited only to future dysfunction, though. People with excess body weight don’t appear to think as clearly at any age.

    “It was found that obese participants showed broad impairments on executive functions” of the brain, including working memory, decision-making, planning, cognitive flexibility, and verbal fluency. “From resisting temptation to keeping long-term goals in mind, executive functions play a critical role in everyday life,” noted a meta-analysis and review of 72 studies on the issue.

    According to researchers, people may think about their obesity and the resulting stigma they experience as much as five times an hour, but the cognitive deficits do not appear to arise just from distraction; there are structural brain differences between individuals who are at an ideal weight versus overweight.

    A review entitled “Does the Brain Shrink as the Waist Expands?” noted gray matter atrophy across all ages among those carrying excess body fat. It’s this reduced brain volume that has been correlated with lower executive function. As you can see below and at 1:42 in my video The Effects of Obesity on Dementia, Brain Function, and Fertility, compromised integrity of the rest of the brain—the white matter—suggests accelerated brain aging, even in young adults and children with obesity. 

    Cognitive deficits in younger populations suggest there’s something about obesity itself that is affecting brain function, rather than a later clinical consequence, such as high blood pressure. Purported mechanisms for this executive dysfunction include obesity-related inflammation and oxidative stress.

    So, does weight loss improve cognitive function? Based on a meta-analysis of 20 studies, researchers found that mental performance across a variety of domains can be significantly improved with even modest weight loss. However, no studies have yet to be done to determine if this then translates into a normalization of Alzheimer’s disease risk.

    Back to the ABCs of obesity’s health consequences, F is for Fertility—or rather failed fertility. “Overweight and obese persons seeking fertility should be educated on the detrimental effects of fatness and the benefits of weight reduction, including improvement in pregnancy rates,” one meta-analysis concluded. Men also may suffer impaired fertility. The heavier a man is, the greater his risk of having a low sperm count or being completely sterile, as you can see below and at 3:01 in my video. This may be due in part to the effects of excess body fat on testosterone levels. 

    Fat isn’t the primary site of estrogen production in only postmenopausal women, but in men, too. An enzyme in body fat converts testosterone into estrogen. Men losing weight and going from obese to overweight could potentially raise the testosterone levels in their blood by 13 percent.

    A more dramatic cause of infertility in obese men is called a “hidden penis.” The condition, which is also described in the medical literature as a “hidden, buried, concealed, trapped, and inconspicuous” penis, occurs when excess fat in the pubic area subsumes the penis (since its base is attached internally to the pubic bone). The moist enfolding skin surfaces can result in chronic inflammatory dermatitis leading to scarring and requiring a surgical intervention.

    If you missed the previous blog posts, I covered The Best Knee Replacement Alternative for Osteoarthritis Treatment and The Effects of Obesity on Back Pain, Blood Pressure, Cancer, and Diabetes.

    I continue the topic of obesity and weight with videos in the related posts below.

    I cover all of this and more at length in my book How Not to Diet, and its culinary companion, The How Not to Diet Cookbook, has more than 100 delicious, weight-conscious recipes. Request them from your local library. 

    For more on the health conditions discussed in this video, see the Alzheimer’s disease, cognition, and fertility topic pages.  



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  • Social media tiles

    Social media tiles

    Download any of our FREE social media tiles below to use on your own channels. Make sure you share what you're doing far and wide – use the hashtag #guthealthmonth and tag us @dietitianconnection. Please note images should be used in their entirety and not be edited Square images (1000 x 1000…

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  • Obesity’s Impact on Back Pain, Blood Pressure, Cancer, and Diabetes 

    Obesity’s Impact on Back Pain, Blood Pressure, Cancer, and Diabetes 

    Losing weight can reduce sciatica, hypertension, and cancer risk, as well as reverse type 2 diabetes.

    In the ABCs of the health consequences of obesity, A is for Arthritis, as I discussed in my previous blog post, and B is for Back Pain. Being overweight is not just a risk factor for low back pain, but it is also a risk factor for sciatica (a radiating nerve pain), as well as degenerating lumbar discs and disc herniation. Similar to what we learned in the arthritis story, this may also be due to a combination of the excess weight, high cholesterol, and inflammation associated with being overweight. Why cholesterol? Studies of autopsies and angiographies show that the lumbar arteries that feed our spine can get clogged with atherosclerosis and starve the disks in our lower back, as you can see below and at 0:47 in my video The Effects of Obesity on Back Pain, Blood Pressure, Cancer, and Diabetes

    B is also for Blood Pressure. Excess visceral fat—for example, internal abdominal fat—can physically compress our kidneys. The increased pressure can effectively squeeze sodium back into our bloodstream, increasing our blood pressure. Together, the combination of obesity and hypertension can have “disastrous health implications,” but the good news is that just a few pounds of weight loss can help take off the pressure. Losing excess weight has been described as “a vital strategy for controlling hypertension.” In fact, researchers found that losing around nine pounds (4 kg) may lower blood pressure about as much as cutting salt intake approximately in half can.

    C is for Cancer. As many as three-quarters of people surveyed “were unaware that being overweight or obese increased a person’s risk of cancer,” when, in fact, based on a comprehensive review of more than a thousand studies, excess body fat raises the risk of most cancers, including esophageal, stomach, colorectal, liver, gallbladder, pancreatic, breast, uterine, ovarian, kidney, brain, thyroid, and bone marrow (multiple myeloma) cancers, as you can see below and at 2:00 in my video.

    It could be the chronic inflammation of obesity or perhaps it is the high insulin levels due to insulin resistance. (Besides controlling blood sugars, insulin is also “a potent growth factor” that can promote tumor growth.) In women, it could also be the excess estrogen.

    After the ovaries shut down at menopause, fat takes over as the principal site of estrogen production. That’s why women who are obese have up to nearly twice the estrogen levels circulating in their bloodstream, which is associated with an increased risk of developing breast cancer and dying from it. The data on prostate cancer aren’t as strong, though obesity is associated with increased risk of invasive penis cancer. 

    One of the reasons we’re confident the link between obesity and cancer is cause-and-effect—and not just an indirect consequence of eating poorly—is that the overall risk of cancer goes down when people lose weight, even through bariatric surgery. Researchers found that those experiencing a sustained weight loss of about 40 pounds (19.9 kg) after surgery went on to develop around one-third fewer cancers over the subsequent decade, compared with matched individuals in the nonsurgical control group who continued to slowly gain weight over time. The exception, though, is colorectal cancer. 

    “Colorectal cancer is the only known malignancy where the risk of being diagnosed with disease seems to increase after obesity surgery.” Indeed, after bariatric surgery, the rate of rectal cancer death may triple. The rearrangement of anatomy involved in one of the most common surgeries—Roux-en-Y gastric bypass—is thought to increase bile acid exposure along the intestinal lining. This causes sustained pro-inflammatory changes even years after the procedure, which is thought responsible for the increased cancer risk. In contrast, losing weight by dietary means has the potential to decrease obesity-related cancer risk across the board.

    D is for Diabetes. As presented in a consensus statement from the International Diabetes Federation, obesity is considered the single most important risk factor for the development of type 2 diabetes, which is the leading cause of kidney failure, lower-limb amputations, and adult-onset blindness. Ironically, many of the leading drugs used to treat diabetes (including insulin itself) cause further weight gain, creating a vicious cycle. 

    So, again, using lifestyle medicine to treat the underlying cause is not only safer, simpler, and cheaper, but can also be most effective.

    If you missed my previous video, check out The Best Knee Replacement Alternative for Osteoarthritis Treatment.

    Coming up next? See related posts below.

    I continue the topic of weight control with these videos that may be of interest to you: Is the Obesity Paradox Real or a Myth? and Friday Favorites: What’s the Ideal BMI and Waist Size?.

    For more on back pain, blood pressure, cancer, and diabetes, check out their topic pages. 



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  • Top 10 NutritionFacts.org Videos of 2024

    Top 10 NutritionFacts.org Videos of 2024

    We create more than a hundred new videos every year. They are the culmination of countless hours of researching, writing, editing, animating, and producing. We comb through thousands of scientific papers from the peer-reviewed medical literature so busy people like you don’t have to!

    In 2024, I covered a wide variety of hot topics. I released an update on why I changed my mind on water fluoridation, a series on the benefits and side effects of flu, pneumonia, and shingles vaccines, and, of course, a lot on aging and anti-aging based on my research for How Not to Age. Which videos floated to the top last year? 

     

    #10 Benefits and Side Effects of the Flu Vaccine

    Woman sneezing into a tissueRandomized placebo-controlled trials show that flu shots can be extraordinary lifesavers. Can you prevent the flu with foods and supplements, like elderberry and echinacea? See Elderberry Benefits and Side Effects: Does It Help with Colds and the Flu?.

     

     

    #9 The Pros and Cons of Testing PSA Levels for Prostate Cancer

    Doctor and patient reviewing prostate test lab resultsGiven the clear harms and the small and uncertain benefits of PSA testing, most men would presumably decide to decline to undergo it if they knew all the facts, but that’s up to each individual to decide. If you do get diagnosed with prostate cancer, what can you do with your diet, in addition to any other therapies you might choose? See the Prostate Cancer topic page for all related videos.

     

    #8 Are Fish or Fish Oil Supplements Good for the Heart?

    Fish oil capsules spilling out of a jar

    Five massive new trials have been published recently, randomizing tens of thousands to various formulations of fish oil versus placebo. Want to know my omega-3 recommendations? See my Optimum Nutrient Recommendations.

     

     

     

    #7 The Best Dietary Detox

    Assortment of plant based foods from above in bowlsBy eating at a lower rung on the food chain, those choosing plant-based diets aren’t as exposed to the industrial pollutants that bioaccumulate up the ladder.

     

     

     

    #6 How to Lower Lp(a) with Diet

    How to Lower Lp(a) with DietWhat should we eat and what should we avoid to lower the cardiovascular disease risk factor lipoprotein(a)?

     

     

     

     

    #5 Why Do Milk Drinkers Live Shorter Lives on Average?

    Milk being poured into a glassHow might we reduce the risk of premature death from dairy consumption? One way is to switch to soy milk. Check out Is Soy Milk the Most Nutritious Non-Dairy Milk?.

     

     

     

    #4 How to Boost Your Endothelial Progenitor Cells (EPCs) for Heart Health

    Illustration of red blood cellsHow can we improve the capacity of our blood vessels to repair themselves? We can boost the ability of our endothelium to function by eating nitrate-rich vegetables, like beets and greens. See Oxygenating Blood with Nitrate-Rich Vegetables.

     

     

     

    #3 Preventing and Treating Osteoporosis (Webinar Recording)

    image explains the webinar topicIn this two-hour webinar, I cover bone mineral density screening, common over-the-counter drugs like acid blockers that may increase fracture risk, how safe and effective the current oral and injected osteoporosis medications are, which foods may help protect our bones, the best type and frequency of exercise, and how to reduce fall risk.

     

    #2 How Not to Age – Live Presentation

    Dr. Greger and the presentation title on a blue backgroundIn this live lecture, I cover highlights from my book, How Not to Age, which became a New York Times Best Seller. I hope it helps with your New Year’s resolutions. As always, all proceeds I receive from all of my books are donated directly to charity.

     

     

    #1 Can Alzheimer’s Disease Be Reversed with a Plant-Based Diet?

    An assortment of colorful fruits, vegetables, and legumes on a flat surfaceDr. Dean Ornish published the first randomized controlled trial investigating whether a plant-based diet and lifestyle program may reverse the course of early-stage Alzheimer’s disease. What does improving the cognition and function of Alzheimer’s patients with lifestyle medicine actually translate into in terms of human impact? Check out A Testimonial from Dr. Ornish’s Alzheimer’s Progression Reversal Study.

     

    Thank you for being a part of this community. We gained more than 140,000 new subscribers on YouTube in 2024, and the number of people we can reach with this life-saving, life-changing information continues to grow.



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