The South Beach Diet Supercharged: Faster Weight Loss and Better Health for Life (8 page)

Dr. Shoe Shine quickly prescribed a well-known brand of rubber-soled shoes. Though I had long ago learned to wear thick-soled running shoes when I jogged, it had never occurred to me that I should be wearing them for walking or that shin splints wasn’t a malady suffered only by runners. I bought the recommended shoes and have walked long distances at many heart meetings since without a recurrence of shin pain. Still, too many others continue to pound the pavement one way or another without proper precautions, and they’re paying the consequences.

It’s not surprising, then, to learn that experts are predicting that the number of knee- and hip-replacement surgeries will soar as baby boomers reach their later decades. A study published in 2007 estimates that there will be 3.48 million total-knee replacements performed in 2030, a 673 percent increase from the number performed today. The study also predicts that there will be 572,000 hip replacements performed in 2030, a 174 percent increase from today’s number.

This does not mean that you should not exercise.

While it’s true that many of these spare parts will be going to aging athletes who have overworked their joints through the years, even more will be replacing the severely arthritic joints of people who may not have done
enough
exercise. A sedentary lifestyle can lead to being overweight or obese, and that too puts undue stress on the hips, spine, and knee joints. Even a small amount of weight loss can save your knees a lot of wear and tear. With every step you take, you impose a force of from three to six times your body weight across each knee. A 2005 study published in
Arthritis & Rheumatism
found that for every pound of body weight lost, there’s a 4-pound reduction in stress to the knee joint. Considering that you work your knee joints every time you stand or walk, the lighter the load, the better. The point is that overdoing it, as well as doing nothing, will lead you to the same operating room. This is why everyone needs to incorporate joint-friendly exercise and recovery periods into their fitness routines, and the earlier the better.

Smart Fitness

As it happens, many if not most of the boomeritis complaints I see in my office, including rotator cuff injuries and low-back pain, aren’t the result of sports injuries. Rather, they occur in people who are just going about daily chores, like bending over to strap a child into a car seat or picking up a bag of groceries. While some of these injuries are simply the result of weak core muscles and poor flexibility, I also see these problems occurring in the fittest of my patients—or at least the ones that look to be the fittest.

This gets me to another important point. Many people who think they’re doing smart workouts may be doing themselves more harm than good. Conventional weight lifting, sometimes called classic gym, can be counterproductive because it tends to isolate muscle groups and train them in a manner that is not naturally functional. In other words, the workout does not mimic everyday human activities, and it usually neglects the core muscles. The result is muscles that may look good in the mirror or on the beach but aren’t much help when it comes to injury prevention or performing active sports or day-to-day tasks.

The best exercises you can do to prevent boomeritis injuries are called functional exercises. These exercises, which are similar to movements you execute in your daily life, require you to use several muscle groups in one fluid movement. That’s why, in addition to cardio conditioning, our fitness program emphasizes functional fitness to strengthen your core and peripheral muscles. For example, when you lean over to pick up a child or lift heavy bags of groceries from your car, you’re not using just your arms and legs. If you did, you’d be overusing these muscles, leaving them vulnerable to injury. When you bend over to pick something up, you’re engaging all your muscles, including your legs, midline, back, and arms. The core muscles support all your other muscles and help you maintain strength, good posture, and balance.

You may be surprised to learn that as a cardiologist, I place as much importance on core-strengthening exercises as I do on cardio conditioning. The fact is, because this type of exercise promotes stability, strength, and flexibility, it’s essential for preventing injury and maintaining a healthy weight. And if you suffer an injury and you’re in pain, you’re not going to do an effective cardio workout—or any workout at all. In my practice, I see all too many patients who are no longer able to exercise due to injury.

The importance of functional fitness has only recently become appreciated. During my travels, I visit many gyms or fitness rooms associated with the hotels where I stay. I have noticed that more and more of the people who are exercising, with or without a trainer, have incorporated functional fitness into their workouts. I am pleased to find both women and men lifting hand weights while sitting on exercise balls, or using pulley-type machines, or standing on balance boards, which all require them to engage their core muscles as they work other parts of their bodies.

Watch the Core Busters

Of course, our ancestors didn’t have to worry about setting aside time to perform muscle-flexing and strengthening exercises to maintain fitness. They accomplished this while going about their everyday routines. Anthropologists tell us that cave dwellers had remarkably strong muscles and bones, thanks to their normal daily activities. Hunting and gathering was hard work. Stalking and killing prey and finding and picking fruits and vegetables provided a full-body workout. And if you injured your back, you might not survive. Even our very recent ancestors were more physically active than we are. Before society became industrialized, just getting through the day was physically challenging for both men and women. Chopping wood, tending the garden, scrubbing floors, washing clothes on a board or a rock and hanging them up to dry—all involved full and functional body movement.

Today we drive to work, take an elevator to our offices, and sit at our desks all day long. We now use the remote control not just for our TVs but for our sound systems, DVD players, lights, and even curtains. Our kids aren’t running around after school, climbing trees and playing sports like they used to, because they’re home playing video games. Our modern civilized world has created what I call core busters because they prevent our core muscles from getting the activity they were meant to experience. Muscles that aren’t used become weak and stiff, and weak, stiff muscles lead to further inactivity, a sluggish metabolism, and, eventually, injury.

Stop Sitting, Start Moving

We all need to be more aware of the core busters in our everyday lives. Exercising for a few hours a week is great, but we also need to think about what we’re doing the rest of the time. Are we just sitting around, or are we active and moving? Do we walk up the stairs or take the elevator? Do we hail a cab when we could walk? It turns out that the movements we do throughout the day—both consciously and subconsciously—burn calories. And these calories really do add up.

James A. Levine, MD, from the Mayo Clinic, has popularized a concept called NEAT, an acronym for “nonexercise activity thermogenesis.” NEAT reflects all the calories we burn when we are not sleeping, eating, or doing formal exercise. In a study published in 2005 in the journal
Science
, Dr. Levine and his colleagues compared NEAT in two groups of people who did not formally exercise. Half were thin and half were obese. He found that the thin subjects who frequently got up from their desks to walk around or stretch, paced while talking on the phone, or just fidgeted were on their feet during their normal daily routines for 2 more hours than the obese subjects. This translated into burning 350 extra calories per day, enough to explain the difference in weight between the two groups.

In another interesting perspective on the importance of NEAT, William L. Haskell, PhD, of the Stanford Prevention Research Center, estimated that spending 2 minutes per hour sending e-mails rather than walking down the hall to speak with a colleague resulted in a 10-pound weight gain over 10 years. Wow! Maybe switching my office to paperless by using electronic medical software wasn’t such a good idea after all.

The unfortunate fact is that over the last 100 years, the proliferation of labor-saving devices, from the automobile to electronic software, has decreased NEAT by between 500 and 1,000 calories weekly. And this drop has clearly played an important role in our epidemic of obesity. But the impact of NEAT on our society, while disturbing, also presents an important opportunity. We need to plan our workplaces and our daily routines better to make up for all the energy expenditure we have lost because of the activities we no longer do.

NEAT is wonderful news for people who believe that the only way to stay trim and fit is to run marathons. Walking when you could be riding, standing when you could be sitting, and moving when you could be keeping still are easy ways to stay slim and strong for life.

More important, maintaining a healthy weight and doing the right exercise is your best insurance against boomeritis. Following the South Beach Diet and the South Beach Supercharged Fitness Program can help you achieve both of these goals painlessly. And when your spouse or a friend tells you to sit still and stop fidgeting, just say, “No.”

If you’ve had trouble zipping up your favorite pair of jeans lately or had to loosen your belt a notch or two, then beware. Your expanding waistline could be upping your odds of having a heart attack or stroke. In fact, it could even kill you.

One of the most important benefits of the South Beach Diet is that as you lose excess pounds, you also lose inches, especially around your midsection. Women tell me with great pride that for the first time in years, they can wear dresses with waistlines, and some even boast that for the first time in their lives, they can wear bikinis! Men are equally thrilled that when they take off their shirts at the beach, they can show off tight abs instead of a bulging belly. While this is great news for those interested in the cosmetic effects of a diet, it’s even better news for those concerned with avoiding a heart attack and improving their general health.

Walk down a busy city street almost anywhere in the United States today, and you will readily observe that not all overweight people have the same body shape. Some look more like pears, and others look more like apples. If you’d been keeping a count of overweight individuals over the past few decades, you couldn’t help but notice the shocking increase in overweight, apple-shaped Americans. In these individuals, excess fat is concentrated in the belly, whereas in pear-shaped people, most fat is concentrated in the hips and thighs. Ever since French physician Jean Vague first distinguished the android (apple shape) form of obesity from the gynaecoid (pear shape) form in 1947 and observed a connection between apple-shaped obesity and the development of diabetes, hypertension, gout, and atherosclerosis, research has continued to demonstrate that the health implications of body shape are more important than we thought, even just a few years ago.

It turns out that belly fat is different from fat that accumulates directly under your skin. Belly fat is the fat within the abdominal cavity—it’s the fat attached to organs such as the stomach, liver, and intestines. These internal organs are called viscera, and that’s why the fat that attaches to them is known as visceral fat. Visceral fat is like an endocrine organ, producing hormones and other chemicals that have a spectrum of biological effects on the body. And as we shall see, it is these hormones and chemicals that are slowly killing us.

The Proliferation of Apples

Why is our country populated by so many more apple-shaped people, and why should we care? It turns out that the proliferation of apples in America and increasingly around the world is a human survival mechanism gone awry. Understanding this mechanism will help you appreciate what has caused the fattening of America, how it is hurting our health, and what can be done about it.

For early humans, the accumulation of fat during times of feast acted as a fuel reserve that could be called upon for survival during famines. If this fuel reserve was concentrated in the belly, leaving the arms and legs leaner, then a person could still run and hunt without limitation. Consequently, it would be a survival advantage to eat more than normal hunger dictated when food was plentiful and build up this fatty fuel reserve. To use a contemporary analogy, early man protected himself by filling up an accessory gas tank in his belly. When food was abundant in summer and fall, he might fill up the tank by consuming more than was required for his immediate needs. Then he could gradually empty the tank as needed during the winter months, when food was scarce.

This survival mechanism worked fine for millennia, but today most of us live in the midst of a constant feast, without intervals of famine. The hunger that once helped us to store fat in order to survive continues unabated. The result: We’ve become fatter and fatter and fatter, and many of us also have become prediabetic and diabetic.

You may be wondering why in the midst of this constant feast, we aren’t all overweight apples. The reason is fascinating. It turns out that the genes that encourage fat storage—what are called thrifty genes—aren’t distributed equally among societies around the world. Those societies that have experienced subsistence living punctuated by famine in recent times have a generous dose of thrifty genes. If they move from their traditional diet and lifestyle to a Western diet, however, they almost always become obese.

One such society that has been extensively studied is the Pima Indians in the southwestern United States. For centuries, these people barely survived in desert conditions. Their ability to store fat easily when food was available and use it in times of scarcity was a crucial survival mechanism. But in the later 20th century, when the Pimas moved from their traditional lifestyle to a Western one, they experienced a horrible epidemic of obesity that continues to this day. This, in turn, has led to devastating rates of diabetes, early heart attacks, and strokes. Today Eastern Indians who move to the United States and adopt a fast-food diet have the same problems. But they no longer have to move to the United States to experience obesity and diabetes. In New Delhi (and even Beijing), where Western fast-food restaurants are beginning to proliferate, these health problems are becoming more common.

But what about our friends who seem to be able to wolf down large amounts of fries and soda and remain thin? Well, these individuals were born with fewer thrifty genes and are blessed with a genetically rapid metabolism—a great boon in modern times. (If it makes you feel any better, in prehistoric times, these genetically thin people may not have survived.) So, depending on our genetic heritage, we each have a different propensity for accumulating belly fat and becoming an apple or a pear.

The Yin and Yang of Belly Fat

Why is belly fat a problem beyond the cosmetic? Overall, the hormones and other substances produced by visceral fat are proinflammatory. At first glance, this would seem to be good, since inflammation is an important means of fighting disease. For example, if you cut yourself or are invaded by harmful bacteria, your inflammatory response is called upon to first stop the bleeding with the formation of a blood clot, then fight any invader by mobilizing white blood cells to neutralize the bacteria or wall off a foreign body. In appropriate amounts, visceral fat and the inflammatory substances it produces are essential for survival. In fact, when it’s not present in adequate quantity, such as in starving Third World children or those malnourished from cancer or another chronic disease, the inflammatory and immune response underperforms, increasing the risk of infection and death.

When Our Fat Stays Turned On

What happens if we persistently have excess visceral fat? What if our inflammatory response is turned on when we don’t need it? What if it’s on all the time? Because we have become a country of apples and our excess belly fat is continually pouring out inflammatory substances, we are now seeing its unfortunate effects. We’re discovering that there are additional inflammatory chemicals produced by this excess fat, and we’re learning more and more about how they affect the body.

One such substance that’s frequently mentioned in medical news is C-reactive protein (CRP). This protein particle, which can easily be measured in clinical practice with a blood test known as the high-sensitivity CRP (hs-CRP) test, is appropriately elevated when there is infection in the body, but it has also been found in dangerously high levels in people with belly fat, prediabetes, and diabetes. Overall, studies show that we Americans have 20 percent higher levels of CRP than our British cousins. And it is this and other research that indicates that we are indeed a hyperinflamed society.

Paul Ridker, MD, and his colleagues at the Center for Cardiovascular Disease Prevention at Harvard, who did the initial research on CRP, have taught us that elevated levels of CRP are a risk factor for heart disease and that chronic inflammation is intimately involved with atherosclerosis, the buildup of fatty plaque in our arteries that leads to the blockages that cause heart attack and stroke. But we are only now realizing that the scourge of inflammation goes well beyond affecting the heart and blood vessels. In recent years, we have learned that inflammation appears to be a common denominator behind numerous other diseases, including diabetes, Alzheimer’s, macular degeneration, asthma, arthritis, and many forms of cancer. Belly fat and inflammation also appear to play a role in such common conditions as acne and psoriasis.

Belly Fat = Inflammation

Why should inflammatory substances be associated with belly fat? It turns out that an inflammatory response requires energy. If early man was starving, he could not afford the energy expenditure needed for an inflammatory response. All his energy was required just to bring blood and nourishment to his organs. This trade-off meant he was vulnerable to death from injury or infection, and it is probably why our inflammatory response became associated with belly fat. The presence of belly fat in our forebears ensured the fuel reserve that was required for the protective inflammatory response. The fact is, humans were never intended to be carrying around the excess fat so many of us are lugging around today.

So how does this early survival mechanism translate to how we live today? The presence of excess belly fat in such a high proportion of our population is unprecedented. Because we never before had so many inflammation-producing apples, we didn’t understand the extent of the health implications until recently. Just look at heart disease deaths, which had been decreasing over past decades due to improved treatments and better prevention. This favorable trend appears to be reversing itself in America’s younger age groups. A study published in the November 2007
Journal of the American College of Cardiology
showed that in Americans between the ages of 34 and 55—the very ones who’ve had the greatest exposure to processed and fast food—deaths from heart disease are on the rise (so are incidences of prediabetes and type 2 diabetes, two other diseases directly associated with belly fat). Thus, it appears that our sedentary, fast-food lifestyle is trumping even our impressive gains in the treatment of the number one killer of men and women. If things continue as they are, when the current XL generation gets older, matters will be even worse.

The Diabetes—Belly Fat Connection

I cited this statistic before, but I want to mention it again: Today, 40 percent of Americans between the ages of 40 and 70 are prediabetic. The prevalence of prediabetes has tripled over the past several decades, and today most patients in coronary care units are prediabetic or diabetic.

The cause of these burgeoning problems goes back to our fat-storage survival mechanism, which, rather than being lifesaving, has become harmful in modern times. As it turns out, it’s the accumulation of visceral fat that leads to insulin resistance, the condition in which the body produces enough insulin but the cells can’t use it properly (the cells are in fact resistant to the action of insulin). As I noted earlier, insulin resistance causes the exaggerated swings in blood sugar that in turn cause hunger. Without periods of food scarcity, this hunger leads to further fat accumulation. And the more fat you store around your midsection, the bigger your belly-fat cells become. The problem is that insulin does not communicate effectively with swollen fat cells after a meal. As a result, the pancreas has to keep producing extra insulin to overcome the insulin resistance of these larger cells and move sugar and fat from the bloodstream into the tissues. Eventually the pancreas becomes exhausted and cannot produce adequate insulin. When this happens, blood sugar remains elevated after meals, and type 2 diabetes is diagnosed.