From CNN.com.

It should surprise no one in the health or medical field that the diabetes drug Avandia is linked to an increased risk of heart attacks (at least, not after Steven Nissen’s 2007 study of Avandia).  Unfortunately, for most doctors, Plan B is to simply prescribe another drug.

“Don’t worry about the Avandia scare, Mrs. Jones; here, just take Actos or Glynase instead.”

Until some “rogue independent researcher” publishes a meta-analysis showing those drugs will kill you as well, that is.

There is an alternative solution to this problem.  Beware: It’ll require some critical thinking on your part.

1) Understand and acknowledge the role insulin resistance has in diabetes.

2) Understand which foods and foodstuffs raise insulin levels.

3) Avoid eating said foods and foodstuffs.

4) Move around a little bit.  It’d be better if you exercised. It’d be even better if you strength trained.

There you have it.  No 342 page report or dubious drug prescriptions required.

Chris points us to an interesting study involving circadian rhythm and weight gain (to be fair, Melissa sent it to me first, but she doesn’t have a blog).  In the study, nocturnal rats fed during what would have been their sleeping hours gained more weight than rats fed during their waking hours, despite the same overall intake and energy expenditure.

(BTW, if any of you have the full text of the study, might I request a copy?  Pretty please?)

What’s interesting to me is not just the physiological implications of the study (that there might be some unique mechanism that causes animals to store fat more effectively during their snoozing hours), but the statements the obesity experts were quoted as saying:

“How or why a person gains weight is very complicated, but it is clearly not just calories in and calories out,” said Fred Turek, from the Northwestern’s Center for Sleep and Circadian Biology, where the research took place.  “Better timing of meals could be a critical element in slowing the ever-increasing incidence of obesity.”

and

Tam Fry, from the National Obesity Forum, agreed. He said: “It is groundbreaking. It really gets you thinking why this has not been done before.  It could be very dramatic if it affects whether you are going to get fat or not.”

Are you kidding me?

“Better timing of meals?”

“Groundbreaking?”

“Affects whether you are going to get fat or not?”

The study looked at rats that were eating during their sleeping hours.  While I don’t doubt there are some overfat folks eating during the hours they should be sleeping, I highly doubt that 64% of Americans are waking up in the middle of the night and chowing down.  Or perhaps they’re suggesting we’re all operating on schedules that run counter to our normal Circadian rhythms? And these guys are supposed to be experts?

What these folks do is what clients and trainees often do – they lose the forest for the trees.  It’s all too easy to get bogged down in the myriad details of the (admittedly) complex picture of fat loss and lose sight of the one or two most important things which, if done consistently, would yield you 80% or more of the results you’re looking for.  Believe me, if you’re having trouble losing weight, it isn’t because you should be on vampire hours.

There’s nothing wrong with seeking new information or looking to add to your understanding.  But figure out how it falls into the larger picture.

It’s probably old news to you by now, but Time Magazine recently ran an article that ruffled the feathers of most of my fitness industry brethren.

Why Exercise Won’t Make You Thin.

Of course, with a title like that, it’s understandable why fitness folks would be up in arms.  It’s akin to saying, “Why Bankers Steal Your Money” or some similar pejorative.  That there was a huge backlash from the fitness community is unsurprising.  What I find unexpected, however, is the willful ignorance of those so-called fitness “professionals.”  From ad homenim to straw man arguments to overwhelming stupidity, the reaction to Mr. Cloud’s article is flat out embarrassing.  And yet, I’ve read some rebuttals that are sensible and well-presented (wrong, but sensible and well-written nonetheless).

I even had one of my colleagues say, “Thanks, TIME Magazine, for making the job of the fitness professional even more difficult.”  Give me a break.

Look, the honest truth is Cloud is a terrible journalist who makes amateurish mistakes (turning fat into muscle?) and weak arguments, but that doesn’t make his central theme – that exercise does next to nothing for fat loss if you don’t modify your eating – wrong.

By avoiding discussion of this central theme, most fitness professionals are making themselves look shady and evasive.  After all, if exercise isn’t all it’s cracked up to be for weight loss, then why tell clients to jump on a treadmill for 30 minutes “to burn fat”?  If exercising for fat loss doesn’t work, and your livelihood is dependent on prescribing exercise for just that purpose, what does that make you look like?

Here is the brutal reality: Exercise for fat loss without dietary modification is an exercise in futility.  Working out feverishly, only to end up losing no weight is so cliche, it’s part of our cultural consciousness.

Americans are fatter than ever, despite exercising more than ever.  WHY?  If you make your living telling people to hop on a treadmill every day or teaching jumps in a Spinning class, I think you have an obligation to answer.

Gretchen Reynolds recently had a couple of interesting stories in the NY Times:

Can You Get Fit in Six Minutes a Week?

Is Your Ab Workout Hurting Your Back?

Re: Getting Fit in Six Minutes a Week:

The take-home message is that researchers found that higher intensity (read: effort) yet short duration exercise bouts conferred equal endurance benefits as exercising at a lower intensity nearly 50 times longer.  In other words, by working your tail off for a few minutes, you’d receive the same physiological benefit as someone who spent 5000% more time at the gym but merely plodded along.

That, I’d say, is significant.  Work hard, kiddies.

With regards to the ab story, all I have to say is:

1. Most of Dr. McGill’s research (neat as it is) was done on spines from human cadavers.  Cadaverous tissue, being dead, doesn’t respond the same way as tissue in a live (read: warm) human body – it is much less elastic and pliable.  So much of the high force data McGill obtained is tainted by the inherent rigidity of cadaverous tissue (since you’ll register higher forces on a more rigid object).

2. Those who advocated “sucking in the abs” as opposed to “bracing” confused contraction with stability.  In the same vein, tightening your shoulder muscles doesn’t mean “pull your shoulders up to your ears.”

3. Unless you’ve got a specific spinal problem you’re working on (with a qualified professional, I hope), you’ll be well served by working the basic exercises with a heavy (for you) weight.  Performing multi-joint exercises that require abdominal stability will adequately work your core.  Am I saying don’t do side bridges or bird dogs?  No.  But what I am saying is if you’re crunched for time, get your squats in first.

From allvoices.com:

For those of you scratching your heads and saying, “What the heck is JUPITER?”, JUPITER is the latest study purporting to show cardiovascular benefit from taking statins.  In other words – take a statin, prevent a heart attack.  After the disastrous results of the ENHANCE study, statin supporters really needed a win – and they apparently got one in JUPITER (or did they?  Skip to the last paragraph in this post for the punchline; otherwise, read on).

(For the interested – my favorite article on the JUPITER study, and the actual study itself.)

Some necessary science:

If you’re a regular reader of my blog, you’ll know that I’m no fan of statins.  Why?  Because they are used to lower cholesterol levels in an effort to reduce incidence of heart disease.  What’s so bad about that, you ask?  First, there’s really no compelling evidence to suggest that cholesterol levels are tied to heart disease, so trying to thwart heart disease by reducing cholesterol – specious at best.  Second, there’s ample evidence (and plenty of reports) that statins cause nasty side effects – liver damage and muscle wasting, to name two outstanding ones.

A drug that doesn’t do what it purports to do, while injuring the patient who’s taking it?  Sounds iffy to me.

It’s undeniable that statins do decrease cholesterol levels, and that they’ve been to shown to have a (slight) protective effect in males over the age of 65 who’ve had a previous cardiac event (and no beneficial effect to all other groups).  But what’s been disputed is just how they deliver that benefit.  After all, if lowering cholesterol doesn’t protect against heart disease, then what’s providing the protective effect?

Answer: Decreased inflammation.

Chris Masterjohn’s awesome chart shows that increased inflammation causes levels of cholesterol to rise, and that statins decrease cholesterol production indirectly by inhibiting HMG CoA reductase (and consequently, decreasing mevalonate production – a precursor for cholesterol synthesis).  Note that by affecting the pathway so high up, statins have other effects as well (decreased Rho activation, for one).

In simple English – statins don’t work by walking up to rogue LDL particles and hacking them into tiny pieces, they prevent the body from making them altogether by cutting off the supply of raw materials.  And cutting off these raw materials makes it so that the body can’t manufacture other compounds, either; some that lead to harmful outcomes (i.e., inflammation).

C-reactive protein is a marker for inflammation; the more CRP you have, the more inflammation you have.  And as you can guess, that isn’t a good thing for longevity.  Well, it turns out that because subjects in the study had low LDL and total cholesterol levels but high CRP levels, the JUPITER study may force doctors to reevaluate the validity of the lipid hypothesis (that cholesterol causes heart disease).

I guess you could say that’s the one good thing to come out of the JUPITER study.

Ok, so enough dancing around it – the punchline:

The study was originally meant to track all patients for five years, but the results were so robust that it was terminated after a median follow-up of 1.9 years. In March an independent panel of observers halted it because they considered the effects of the drug to be so beneficial that it would have been unethical to keep the control group on a placebo (emphasis mine).

Oh really?  Is that the reason why?  Or could it be because of this (quoted from the actual study):

The rosuvastatin group did not have a significant increase in myopathy or cancer but did have a higher incidence of physician-reported diabetes (emphasis mine).

Did the independent panel really halt the trial because they were oh-so concerned for the well-being of the placebo group?  Or was it because they were worried that the wonderful results of the Crestor group would be slightly marred if they developed diabetes?

Or could it be that they halted the trial because they got what they wanted (great results for the statin group) and wanted to stop before any of the long-term problems that plagued participants of prior studies (like cancer and stroke in the ENHANCE and SEAS studies) had a chance to develop?  In his insightful post on this topic, Dr. Eades mentions that:

…it is typical for an outside group to take a peek at the data at certain milestones to make sure the study medication isn’t killing people…I’ve never seen a study halted because the placebo group was dying at higher rates. That really makes me wonder.

I don’t doubt that there was foul play afoot.  After all,

…physician-reported diabetes was more frequent in the rosuvastatin group; these events were not adjudicated by the end-point committee.

“We didn’t study it so it didn’t happen”, or something like that.  Sounds like they got out while the gettin’ was good.

UPDATE #1: Peter shows us why it’s so important to look at the actual data.  Deaths from cardiovascular disease in the statin group were higher than the controls (the controls had more incidence of CV disease, but fewer deaths).

UPDATE #2: Sandy’s review of JUPITER is ridiculously awesome.  Set aside an hour and read it.

Above: Could he really medal in any event in the Olympics? Dr. Paul Zehr would say so.

Ronen sent me this neat-o article on the physiological basis of Batman. Don’t take it too seriously; it’s just some light-hearted conjecture (real science, of course) on Batman’s physical abilities by an associate professor of kinesiology and neuroscience. Enjoy.

I’ve taken a nod from Scott and installed a Skribit widget on my sidebar.  It’s the nifty little box that says, “What topics would you like me to write about?”

I’ve no shortage of topics to blog on (the time to write; that’s another story…), but most of my blog topics come from the day-to-day conversations, Q and As, and discussions I have with clients, friends, and colleagues.  I thought it might be interesting to see what topics you folks out there in cyberspace are interested in.

It’s a cinch – just click on “What topics would you like me to write about?”  A box pops up prompting you to enter your suggestion.  Type it in, click submit, and voila!  Alternatively, you can vote up other suggestions if someone else beat you to the punch and asked your question already – just click the little vote icon after the question.

So, if you’ve got a question or something you’d like me to rant about blog on, go right ahead.

*** Warning – Spoilers ahead! ***

Pixar’s Wall-E is cautionary tale; not just of the environment and planetary stewardship, but personal stewardship as well. Although a work of fiction, the film is scattered with reminders of how lack of movement and poor diet (and lack of self-responsibility) can lead to obesity and early death in real life.

Some takeaway lessons from the film:

1) Use it or lose it:
Over the course of 700 years (and many generations) of overfeeding and sloth, the nomadic human race has not only grown fat, but has lost most of its bone and skeletal structure. In fact, the average person has lost the ability to stand (which makes for a funny scene when Wall-E accidentally knocks “John” over).

All’s not lost, however; humans regain their ability to stand and walk (somewhat unbelievably, but hey, it is an animated film) and farm and fish – more on this later.

2) Drinking your calories is a bad strategy:
A perennial in top ten fat loss tip lists is not to drink your calories; i.e., don’t drink caloric beverages as it’s all too easy to consume hundreds of calories (and sugar) without realizing it. The future humans in Wall-E take this to the extreme with drinkable meals (pizza?) served up in 7-11 Big Gulp-sized cups.

3) The less you move, the less you’ll move:
The human body, made up predominantly of third-class levers, is designed for movement. Often, pain (and immobility) occur from disuse. The classic example?

Your job becomes all-encompassing and you forego exercise, thinking, “I don’t have the time or energy.” Over time, the muscles in your back begin to atrophy and you start to experience back pain. This new development makes you less inclined to move around at all (much less exercise) since even bending over causes discomfort, so subtly, you begin to curtail your general activity. All the while, of course, your lower back muscles continue to deteriorate (the pain increasing accordingly). Before long, it hurts to walk. You begin to walk differently, placing more stress on your knees. Then, one day, you start to notice a painful ache in the lateral side of your right knee…

Physical therapists call this “The vicious cycle of pain.” Pain from disuse atrophy makes you less inclined to move, which further exacerbates the atrophy, which further exacerbates the pain. The solution? Use your body. Better yet, lift heavy things.

4) There is a silver lining:
The humans eventually return to Earth, harkening a return to subsistence farming and the consumption of real food – and progressively get skinnier and skinnier (according to the credits). It’s notable that the skinniest incarnation of human is the one depicted as fishing for subsistence. Is it possible Andrew Stanton recognizes the impact of food selection on obesity?

Mr. Stanton’s motives aside, the point still rings true: If you go back to eating real food and moving around once in awhile, there’s still hope, no matter how far overfat you are. Hey, if Manuel Uribe can lose 55% of his body mass (about 670 lbs) through diet and exercise alone, I’d say there’s hope for everybody.

P.S. – While I hate to admit it, I liked Wall-E a great deal, and not for the reasons listed above (my wife always says I’m a sucker for great design).

An unintentionally funny pic by way of Dr. Eades:

And leaves and berries. Don’t forget the nuts and seeds too.