Obesity Info from Life Extension Foundation

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ObesityUpdated: 11/19/2004

Facts On Obesity Why Obese People Can't Loose Body Fat The Pathology Of Obesity Initial Treatment For Obesity The Scientific Premise Behind Early Day Eating Today's Diet Fallacies Fiber The Glycemic Index Thyroid Deficiency And Weight Gain Other Hormone Imbalances Fat-Loss Supplements How Body Fat Accumulates How Guarana Induces Fat Loss CLA + Guarana The "Friendly" Fats Chromium Magnesium Stevia Implementing A Natural Weight Loss Program Summary Appendix A Appendix B Appendix C Appendix D Appendix E Appendix F Appendix G Appendix H

As people age, they often accumulate excess body fat. Weight gain not only creates cosmetic problems, but it also contributes to disorders such as Type II diabetes, cardiovascular disease, cartilage breakdown, sexual dysfunction, and even cancer. Typical approaches to conventional weight loss have a high failure rate. However, the scientific literature provides data indicating that sustained weight management is attainable.

Carrying extra pounds has a profound impact on our health and well-being. Perhaps the most devastating emotional impact of being overweight comes from the frustration of continued dieting without success or ending up heavier than ever after following a diet.

Many physicians fail to realize that no single fat reduction protocol will work for everyone. That is why overweight people must follow a custom-tailored program to modulate factors in their body that result in excess fat build-up. There are several common culprits that cause aging people to add body fat and to also prevent them from losing it. These missing links are often overlooked, and the result is that most weight loss programs fail.

In this protocol, the mechanisms involved in age-associated weight gain will be discussed, and how an individual can circumvent these metabolic imbalances will be described. Most important, overlooked factors that preclude successful weight loss in the majority of people who try to "diet" will be revealed.

DefinitionObesity is defined as an excess accumulation of body fat associated with increased fat cell size and number. The term overweight denotes excessive body weight relative to height.

The most common medical assessment of obesity is "body mass index." Body mass index (BMI) is calculated based on body weight (measured in kilograms) divided by height (measured in meters squared). A person is considered overweight if they have a BMI of 25-29.9. A person with a BMI greater than 30 is classified as being "obese" (Flegal et al. 1998).

THE FACTS ON OBESITY

Dangers of Obesity Economic Costs Dietary Trends

The majority of adults in the United States are overweight (BMI over 25), with an increasing number being medically classified as obese (BMI over 30). Unfortunately, the trend is increasing. The prevalence of obesity in the United States has almost doubled compared to the year 1980 (NIH 1998; WHO 1998).

The Dangers of ObesityIt is clear that excess weight has a dramatic impact on one's health. Obesity is the second leading cause of preventable deaths (tobacco being first). Overweight and obesity are known risk factors for diabetes, heart disease, stroke, hypertension, gallbladder disease, osteoarthritis, sleep apnea, and some forms of cancer (uterine, breast, colorectal, kidney, prostate, pancreatic, and gallbladder).

Obesity is associated with stress, incontinence, complications of pregnancy, menstrual irregularities, excess facial hair, increased surgical risk, and psychological disorders such as depression. Epidemiological evidence supports popular belief that the BMI associated with the lowest mortality falls within the range of 18.5-24.9, i.e., thinner people live much longer (Baird 1994; s 2000).

Weight gain in adulthood is associated with significant increased mortality. In the famous Framingham Heart Study, the risk of death increased by 1% for each extra pound (0.45 kg) increase in weight between 30 and 42 years of age and increased by 2% between 50 and 62 years of age ( et al. 1997; Kopelman 2000). The subjects in the Framingham Heart Study were followed for 26 years. Another study found that fat loss was associated with a decrease in mortality rate ( et al. 1999).

Economic CostsThe healthcare costs related to overweight and obesity are staggering. According to statistics collected in 1995, the direct economic cost of dealing with excess body fat in the United States was $99.2 billion. The indirect costs were projected at $47.6 billion due to wages lost by people unable to work because of illness or disability (Cerulli et al. 1998; Wolf et al. 1998; Colditz 1999). Both the direct and indirect costs of dealing with obesity are skyrocketing. For instance, many airlines require obese individuals to fly first class or to purchase two coach seats because other passengers refuse to sit cramped in a narrow seat next to an obese person who cannot fit into their own seat.

Dietary TrendsIn the year 2002, the Surgeon General estimated that 65.4% of Americans were clinically overweight (having a BMI of 25 or greater) of which 30.5% are considered obese. As noted earlier, a person with a BMI greater than 30 is classified as being "obese" (Flegal et al. 1998).

According to the National Institutes of Health, adults who have a BMI of 25 or more are considered at risk for premature death and disability as a consequence of overweight and obesity. These health risks increase even more as the severity of an individual's obesity increases (NIH 1998).

The statistics on obesity in the United States are alarming. To make matters worse, the prevalence of obesity has been steadily increasing over the past decades. Perhaps even more disturbing is that this increase often occurs simultaneously with a decrease in average fat intake and total calories, along with a dramatic rise in the consumption of low-fat products. There was no change in the prevalence of sedentary lifestyle. According to this report, people are adding more weight even though they are eating less fat and exercising regularly (Heini et al. 1997). More recent reports, however, indicate that many Americans are consuming too many calories, while simultaneously reducing physical activity (Serdula et al. 1999; Astrup 2001; Mokdad et al. 2001).

As you will learn later, acutely cutting calorie intake is not the ideal way of achieving long-term weight control in the obese and in fact may preclude successful fat loss in many overweight individuals.

WHY OBESE PEOPLE CANNOT LOSE BODY FAT

Insulin's Insidious Dark Side Why Diets Fail Too Much Insulin Causes Severe Disease States Why Insulin Makes People Hungry JAMA Study Indicates Hyperinsulinemia Causes Hunger Today's Diet Controversy Cutting Calories

There are several hormones that impact how many ingested calories are stored as body fat. If any of these hormones are out of balance, a person can gain weight even though they may eat less food. One hormone that exerts a significant effect on hunger and fat storage is insulin.

Insulin is produced by beta cells in the pancreas mainly in response to high levels of glucose (sugar) in the blood. Insulin enables the liver to store excess serum glucose. Insulin also stimulates the liver to form fatty acids that are transported to adipose cells and stored as fat. The net effect of insulin is the storage of carbohydrate, protein, and fat in the body.

A poor diet can induce the pancreas to secrete large amounts of insulin. Aging people also experience metabolic disorders that cause the hypersecretion of insulin. Eventually the cells in the body become resistant to insulin (by decreasing the number of insulin receptors).

As cells become insulin resistant, the body stabilizes blood glucose by producing higher levels of insulin. The effect of high insulin production is weight gain. The long-term result is often Type II diabetes in which blood glucose levels become unstable even though insulin levels remain dangerously high.

As people accumulate excess body fat, they develop a chronic condition known as hyperinsulinemia, meaning the pancreas constantly secretes too much insulin and the body is unable to effectively utilize it.

A novel approach to fat loss has been developed based on the established fact that overweight people have too much insulin in their blood. Insulin causes sugar and dietary fats to be converted to body fat. Excess insulin prevents stored body fat from being released, even when a person undergoes severe calorie restriction, such as in crash dieting.

Poor diet, obesity, aging, and metabolic disturbances result in the excessive secretion of insulin, a factor in the development of Type II diabetes. Suppressing excess insulin production is a crucial and often overlooked component of a fat-loss program.

The role of excess insulin in causing weight gain has been an accepted scientific fact for years (Beeson et al. 1971; Woodward et al. 1989; Heller et al. 1994). Building on this observation, some scientists have postulated that it is impossible for people to lose significant body fat as long as they have insulin overload.

A noticeable effect of surplus serum insulin is constant hunger, which results in a vicious cycle in which overeating causes more and more body fat to accumulate, which in turn causes even greater amounts of unwanted insulin to be secreted from the pancreas. We now know that hyperinsulinemia predicts diabetes mellitus (Haffner et al. 1990; Kekalainen et al. 1999; Weyer et al. 2000). Even in children, serum insulin levels are far higher in obese than in non-obese children of the same age.

Insulin's Insidious Dark Side Type I diabetes, characterized by a severe deficiency of pancreatic insulin secretion, was at one time universally fatal. In 1922, a young boy received the first form of supplemental insulin and experienced a reduction of blood sugar. Insulin was soon viewed as a wonder drug because it saved the lives of people who were previously doomed to die shortly after diagnosis. Since Type I diabetics do not produce enough insulin, supplemental insulin for these individuals is a life-saving therapy. Most people consider insulin to be a "healthy" hormone, but insulin has an insidious dark side.

Because the aging process and poor diet deprives cells of insulin sensitivity, many people produce excess levels of insulin to force serum glucose into cells. This excessive insulin production is a contributing cause to a host of degenerative diseases including cardiovascular disease and cancer.

However, the most immediate and noticeable effect of excess insulin production is unwanted weight gain. When the blood is saturated with insulin, the body will not release significant fat stores, even when a person restricts their calorie intake (diets) and exercises. Insulin drives fat into cells, prevents fat from being released from cells, and makes people chronically hungry. Not only do high insulin levels contribute to obesity, but chronic elevated insulin in and of itself also contributes to the multitude of disease states associated with being overweight.

Insulin saves the lives of Type I diabetics who are insulin-dependent, but it becomes a "death hormone" to aging people who secrete too much insulin. Reducing serum insulin is thus a critical component of a weight reduction program.

Why Diets FailThe fact that 64.5% of Americans are overweight is dramatic testimony to the ineffectiveness of all existing weight loss treatments. On any given day of the year, at least half of these people are trying--earnestly trying--to lose weight.

We know that "dieting" (eating less of something than you usually do) only results in short-term loss of weight. Dieters typically lose lean tissue and not fat.

Because insulin blocks the release of fat from storage, most people will not lose stored fat by lowering food intake as long as any insulin is present in the blood.

Too Much Insulin Causes Severe Disease StatesA surprising number of studies report that excess serum insulin (hyperinsulinemia) is a major health problem. It appears that excess insulin promotes hypertension by impairing sodium balance. Too much insulin harms the kidneys. The vascular system is severely damaged by prolonged exposure to excess insulin. By acting as a catalyst in promoting cell growth, excess insulin increases the risk and progression of certain cancers. Excess insulin is a contributory factor to benign prostate enlargement because it promotes overgrowth of prostate cells.

For people trying to reduce body fat, excess insulin suppresses the release of growth hormone and prevents fat from being released from fat cells. High serum insulin is associated with the development of abdominal obesity and a number of health problems, including atherosclerosis and impotence. Obesity is associated with excess insulin and reduced insulin sensitivity, both risk factors for Type II diabetes.

Perhaps the simplest method of evaluating the toxic effects of excess insulin is to look at its effects on human mortality. One early study showed that over a 10-year period, the risk of dying was almost twice as great for those with the highest levels of insulin compared to those with the lowest. The scientists stated that hyperinsulinemia is associated with increased all-cause and cardiovascular mortality, independent of other risk factors (NIH 1985). Aging people experience a wide range of degenerative diseases that are directly attributable to elevated insulin.

Standard laboratory reference ranges can sometimes be misleading. For instance, it was once considered normal to have a cholesterol reading of up to 300 mg/dL. While it is true that a cholesterol count of 300 was normal at that time in history, so was an epidemic of heart attacks. Once the dangers of high cholesterol became known, laboratories reduced the high normal reference range to 200 for cholesterol. We expect that laboratory reference ranges for postprandial insulin will eventually be changed to alert physicians to patients with dangerously high serum levels of insulin.

Why Insulin Makes People HungryOne of the ways that excess insulin results in weight gain is that it causes people to be chronically hungry. A reason for this is that high insulin levels rapidly deplete glucose from the blood. This causes a state known as "reactive hypoglycemia," in which the blood becomes relatively deficient in glucose because too many insulin spikes are causing very high levels of insulin in the blood.

Low blood sugar-induced by hyperinsulinemia--produces a ravenous craving for glucose-producing foods. This elevated insulin state promotes excess food intake and leads to a cycle where even greater amounts of insulin are produced to balance the increased calorie intake. The continuous consumption of glucose-producing foods leads to even more insulin secretion and contributes to the pathological accumulation of body fat.

Published studies show that even modest decreases in blood glucose concentrations are associated with hunger and the initiation of eating (Ludwig 2002). Indeed, insulin-induced hypoglycemia appears to provoke prolonged hunger, persisting long after restoration of normal blood glucose levels.

Furthermore, hyperinsulinemia (Kopf et al. 2001) and reactive hypoglycemia (Wursch et al. 1997) may preferentially stimulate consumption of high-glycemic index foods, leading to cycles of greater insulin secretion, followed by low blood sugar and the inevitable desire to rapidly consume more calories. Weight loss efforts (dieting) may exacerbate this phenomenon, as demonstrated by severe hypoglycemia after overweight subjects who were dieting consumed a high-glycemic index carbohydrate (Ludwig 2002). This helps to explain why so many diets fail, i.e., chronically high insulin levels cause people to crave the very carbohydrates that are making them fat. As you will learn later in this protocol, changing the type of food ingested is not a cure for obesity. However, consumption of PGX soluble fiber blend can blunt postprandial rises in both glucose and insulin which contribute to obesity.

JAMA Study Indicates Hyperinsulinemia Causes HungerThe anti-obesity potential of reducing serum insulin was reported in a study in the Journal of the American Medical Association (JAMA) that described the effects of serum insulin increase (hyperinsulinemia), hunger, and weight gain that ensues. The study concluded by stating: "It is possible that the hunger incident to hyperinsulinemia may be a cause of overeating, and therefore, the obesity that so often precedes diabetes" (Ludwig 2002).

Healthy people secrete enough insulin to efficiently metabolize glucose. Once enough glucose is taken up by the cells and removed from the blood, insulin then drops to very low levels in these metabolically balanced individuals. Overweight people, on the other hand, typically suffer from a metabolic disorder that results in elevated insulin secretion because the pancreas is attempting to overcome insulin insensitivity and drive excess glucose out of the blood.

There are serious misconceptions about why people accumulate so much body fat as they age. One overlooked factor is that overweight/obese people have startlingly high levels of insulin in their blood. When the blood is saturated with insulin, the body will not release significant fat stores, even when a person restricts their calorie intake and exercises.

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Obesity

Today's Diet ControversyThe role that excess insulin plays in inducing and maintaining obesity has not gone completely unnoticed. A number of popular weight loss books advocate dietary alterations that reduce or eliminate all high-glycemic food groups in order to suppress excess insulin secretion. Some of these diet programs go as far as to prohibit ingestion of healthy fruits.

Most obese individuals suffer from severe metabolic disorders that are not readily correctable by altering the amount or types of foods they consume. When we refer to the term "metabolic disorders," we are describing a host of pathological biochemical imbalances in an obese individual's body that significantly precludes an individual from losing body fat. These same metabolic disorders also cause or contribute to the myriad of diseases associated with obesity. The information contained in this Obesity protocol explains how to correct the metabolic disorders responsible for inducing obesity and associated diseases.

The most compelling question confronting overweight Americans is: Why is no effective treatment available? Although scientific advances have been made in defining the metabolic mechanisms that occur in our bodies after we ingest calories, medicine has not progressed beyond the you-ate-too-much-so-you-got-fat concept.

The intrinsic difficulty with such simplistic explanations for weight gain is the fact that overeating does not automatically make a person become fat. We all know people with an unfair ability to eat anything and everything without gaining an ounce. There are published studies showing that dieting does not make an obese person thin over the long term (Toubro et al. 1998; Brand- et al. 2002). Another study demonstrated no weight loss differences when obese individuals consume either high or low glycemic index diets (Astrup et al. 2002).

Blaming different types of food--or blaming the patient him or herself--may be popular, but it is monumentally unproductive. This attitude started in the early 1950s when scientists at the Rockefeller Foundation postulated that an increase in obesity that followed World War II was caused by excess protein consumption. Noting that 56% of the protein eaten leaves the liver and enters the blood as glucose after the liver converts this excess of protein to glucose. They presumed this to be the source of excess sugar, which is easily converted by the liver into fat and then stored as fat. However, restricting protein intake did not end the problem of obesity.

Caloric restriction "diets" and low carbohydrate diets have dominated for years because they do induce quick weight loss. Unfortunately, they do not cause significant fat loss. Too often, the weight that an obese person loses on a low carbohydrate diet not only comes back, but also will come back containing more fat than the weight lost through the painful diet.

One of the problems with modern diets is that they forget scientific principles that were long ago established relating to what happens when a person suddenly reduces calorie intake. For example, if a person cuts calories from their normal diet, they initially lose a lot of protein, and its accompanying extracellular water, but almost no fat. The reason for the failure of diets to initially induce fat loss is that chronically high insulin levels in those suffering from this condition preclude the release of fat from storage in the body. Since insulin blocks fat release, the body first burns up its protein reserves in response to dieting, which results in a quick reduction of body (protein) weight, but virtually no loss of body fat.

People can easily lose total body weight when dieting, but fail to eliminate enough fat to resolve their obesity problem. When normal food intake is resumed, lost protein tissue is replaced with even more body fat. Later in this Protocol we will describe a soluble fiber blend diet that blunts postprandial elevation of glucose and insulin; offering a diet that can be recommended over other controversial diets.

There are other metabolic adjustments that the body makes in response to lower food intake that can make it difficult to lose fat. People respond to a drop in food intake by immediately lowering production of the enzyme (5-monodeiodinase) that converts the relatively inactive thyroid hormone, thyroxine, to T3. It is T3 (triiodothyronine) that promotes oxidation of glucose and its metabolites. Reduced levels of T3 cause conservation of calories, meaning that the body automatically burns fewer calories at rest. The minute a person cuts calories, whether from carbohydrate, fat, or protein, they turn down the rate at which calories are burned (Braverman 1996)! Overcoming a thyroid hormone (T3) deficiency will be discussed in more detail later in this protocol.

Cutting Calories/Carbohydrates Adds Fat!Reduction in caloric intake causes a decrease in T3 levels (Merimee et al. 1976; Carlson et al. 1977; Palmblad et al. 1977; Vagenakis et al. 1977; Beer et al. 1989; Wadden et al. 1990), even when the decrease is caused by bypass surgery of the gut (Wilcox 1977). Reduction of T3 is equal whether caused by lowering total calories or just carbohydrates (Spaulding et al. 1976; Azizi 1978). T3 is the more calorigenic form of the two thyroid hormones. Lowering T3 automatically lowers the basal metabolic rate and favors conservation of energy--in other words, if excess calories are present fat is stored!

THE PATHOLOGY OF OBESITY

The Insulin Trap

Although many people experience life-long weight problems, many more find themselves beginning to gain weight as they age. The underlying metabolic disorder is the same, but the existence of the pathological factors involved in this condition is more easily understood in studying individuals who were thin in their youth. The primary difference between the two groups is not in the functional manifestations of the condition, but in its origin.

Elegant research involving sets of identical twins has confirmed beyond question the role of genetic predisposition in the etiology of life-long obesity (Hainer et al. 2001; Koeppen-Schomerus et al. 2001; Poulsen et al. 2001; Kunesova et al. 2002a,. If one of two parents is obese, the chances of their offspring developing obesity are 4 in 10 (40%). If both parents were overweight all their lives, the chances jump to 80% that the offspring will also be overweight. However, the metabolic changes that cause weight gain are virtually the same in both inherited and acquired obesity. Correction of these functional changes will result in normalization of weight whether the obesity is inherited or a consequence of aging.

Those who start out life being slim enjoy the seemingly unfair ability to eat as much as they want of whatever they want without ever gaining weight. They rarely pay any attention to their diets and take for granted that their clothing will always fit.

Most individuals begin a steady march into obesity during their late twenties. It is in the late twenties that most people begin to lose muscle mass--unless they work hard to retain it. Between the ages of 26 and 28 that loss of muscle mass can represent from 3-10% of lean tissue. Some are lucky enough to not see an increase in body fat replacing the lost muscle for 5 or so years. Those who are athletic may not notice that their slim days are behind them for 10 or 12 more years. However, by age 39 the vast majority of Americans are forced to face the fact that they are overweight.

The normal changes of aging that make it easy for people to gain weight include alterations in endocrine hormone levels. Unfortunately, insulin, cortisol, and estrogen (in men)--hormones that do not decrease as we grow older--favor fat gain. Later in the protocol, you will learn how each of these hormones plays a role in causing people to add fat and what can be done to restore a more youthful hormone balance that promotes calorie wasting rather than fat storage.

The Insulin TrapPrior to the 1950s, scientists believed that stored fat was relatively inert and that once adipose (body fat) tissue was formed, very little metabolic activity took place in fat cells; however, it was then learned that the triglyceride stores of fat tissue are constantly turning over (Bjorntorp 1996). An enzyme called lipoprotein lipase controls the passage of fat precursors into the fat cell. The breakdown of stored fat and the passage of these breakdown products out of the fat cell are controlled by a different enzyme, hormone sensitive lipase. Insulin prevents the action of the second enzyme (hormone sensitive lipase).

As long as insulin is present in the blood, stored fat cannot be mobilized--it is locked into the cell. The bad news is that fasting insulin levels are elevated in obesity (Kolterman et al. 1980). In normal health, when glucose in blood drops below 83 mg/deciliter, insulin effectively vanishes. When an individual is overweight, insulin never vanishes.

Insulin not only keeps fat in storage, but insulin also stimulates the production of new fat. It even lowers levels of the amino acid carnitine in the liver. Carnitine is needed to carry fat precursors into the mitochondria, where the fat precursors can be burned as heat to "waste" calories.

As the undeniable role of insulin in causing and maintaining obesity has come to the attention of popular "diet" and "weight-loss" experts, many useless solutions have been suggested. Restriction of carbohydrates or of high glycemic foods arose from the observation that elevation in blood glucose is a primary stimulus of insulin release. However, it is not the only stimulus. Amino acids such as L-leucine have a strong effect on insulin release, as do many digestive hormones (Galabova et al. 1976; Malaisse et al. 1984; Giroix et al. 1999).

The early demonstration that glucose given orally produces a much greater insulin surge than the same amount of glucose given intravenously proved that elevation of blood glucose alone is not the source of hyperinsulinemia (Mclntyre 1978). This enhanced release of insulin is thought to be caused by gut hormones.

Obesity and metabolic diabetes (in the early stages) are also associated with an increase in the mass of the tissue that produces insulin, the beta cells of the islets of Langerhans (Mclntyre 1978). Both high-carbohydrate and high-protein diets have the same stimulatory effect on increased islet cell mass.

As long as insulin is present in the blood, fat cannot be released from storage. Thus, the weight lost by overweight people in response to "dieting" is largely protein and water. "Dieting" or lowering food intake can be seen to have two disastrous effects on obesity:

Lowering of metabolic rate by turning down conversion of T4 to T3 Depletion of lean tissue

Exercise, the other popularly prescribed "treatment" modality, has only one disastrous consequence for obese individuals: exercise lowers the need for insulin because it promotes glucose uptake by muscle cells without the presence of insulin (Kirwan et al. 2002; Reynolds et al. 2002). Obese individuals already have too much insulin. Therefore, exercise causes the excess to be that much more excessive!

Please note that all these statements refer to persons who are overweight. Caloric restriction and exercise are beneficial for individuals who are thin.

INITIAL TREATMENT FOR OBESITY

Although what an individual eats may not have a critical influence on weight gain, when an individual eats most certainly does ( et al.1999). Early observations had also indicated that the majority of obese people take in most of their daily calories in a relatively short period in the evening (Dole et al. 1953; Stunkard et al. 1955, Hollifield et al. 1964). Based on these observations, a first step in treating obesity is changing the time of day when most calories are consumed. By shifting consumption of high-calorie foods from late in the day to earlier in the day, there is great potential that some of the fundamental metabolic disorders (disruptions in glucose, insulin, and leptin metabolism) that prevent obese people from losing body fat can be corrected ( et al. 1999).

In clinical weight loss practice, overweight and obese patients were told to alter the time of day when they consumed their food. The result was rapid and sustained fat loss in those who adhered to the following instructions:

Immediately after awakening, eat a large breakfast. If you want a banana split, eat it at breakfast! Eat as much as you want of whatever you want. The reason we advocate a liberal breakfast is that you should follow this program for the rest of your life. If you are continuously deprived of the foods you like, at some point you might rebel and begin eating at the wrong time of the day. Ideally, breakfast will consist of fresh fruit and whole grains, but if you need to consume high calorie foods or prefer to do so, do so in the morning and not late in the day. Late in the morning, have a snack equivalent in calories to a hamburger and potato fries. Healthier foods are recommended, but for the purposes of complying with this program, eat whatever you want at this time of the day instead of waiting until the evening when these calories readily convert to body fat. Mid-afternoon, have another snack equivalent to the calories obtained from a tuna salad sandwich on whole wheat bread and some fruit. No later than 6:30 p.m., have a modest dinner such as fish or lean chicken, potato, and several vegetable servings. It is critical that no food be consumed after 6:30 p.m. This program is designed to achieve this critical purpose, i.e., to normalize fasting insulin so that body fat can be released from storage.

Most important of all is that you consume two to six capsules of PGXâ„¢ highly viscous fiber blend (1,000-3,000 mg) 5-10 minutes before each meal with 8-16 ounces of water. This recent discovery is described in greater detail later in this Protocol.

It may take a week for some obese individuals to wake up hungry (as they are supposed to do) and not have the desire to eat after 6:30 p.m. After 45 days of following this program that alters the time of day when calories are consumed, an improvement in several metabolic parameters should become evident, including a reduction in postprandial insulin levels. Enough fat loss should have occurred during this initial 45-day period to motivate an individual to reduce total calorie intake and begin to exercise.

Following this five-step program described has resulted in many overweight patients achieving a normal weight in a relatively short time period. Most obese individuals experienced sustained reductions in body fat, especially in the abdominal area. Some patients did require additional therapies to correct underlying metabolic disorders responsible for their inability to lose body fat. These supplementary therapies will be discussed later in the protocol, but first the beneficial mechanisms that occur when the calorie burden is shifted to early day eating will be explained.

THE SCIENTIFIC PREMISE BEHIND EARLY DAY EATING

The American Journal of Clinical Nutrition published a study reporting that food eaten early in the day generates more energy (diet-induced thermogenesis) than food eaten later in the day (Weststrate 1993). What this study demonstrated was that the metabolic rate of the body is high enough early in the day to burn off calories as energy, whereas these same calories consumed at night can be stored as fat. Based on these types of scientific findings, progressive physicians have advocated that overweight patients not eat anything after 6-7:00 p.m.

However, until recently it was difficult for obese individuals to avoid late night snacking.

In a presentation made at the 43rd Annual Conference of the American Heart Association (March 5, 2003), a study was described showing that people who eat breakfast daily are less likely to succumb to obesity and diabetes. In comparison to people who ate breakfast twice per week or less often, those eating breakfast every day had 35%-50% lower rates of developing obesity and insulin resistance syndrome (Pereira 2003). Dr. Mark A. Pereira, one of the scientists involved in the study, stated that breakfast might reduce the risk of obesity, Type II diabetes, and cardiovascular disease by controlling appetite and thus reducing the likelihood of overeating later in the day. The study included 2681 young adults who were followed for 8 years. Those who ate whole grain breakfast cereals were associated with a reduction in risk, whereas refined grain breakfast cereals were not. The study did not evaluate the nighttime eating habits of these individuals. (Remember: The key to weight loss for severely overweight people is to consume the bulk of their calories for breakfast and avoid eating all food after 6:30 p.m.)

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Obesity

TODAY'S DIET FALLACIES

The Forgotten Science

There are so many overweight Americans that the diet industry has exponentially grown over the past 15 years. Each diet book, clinic, food, supplement, and infomercial claims to have discovered the "real" reason for today's obesity epidemic. However, a cursory review of published scientific literature indicates that the causes of weight gain are multi-factorial. Fortunately, there are established fundamental factors that can be used to induce significant and sustained fat loss. The diet "trap" to avoid is to believe that any one solution is the key to losing weight.

Age-associated weight gain is the end result of numerous degenerative changes that are at least partially reversible. Most Americans with excess body fat were not overweight in their youth. Young people can often consume as much food as they want and efficiently burn off excess calories, but aging results in an excess accumulation of body fat stores, even though the person might be consuming fewer calories. The problem in aging is that healthy metabolic function is impaired and ingested food accumulates as body fat.

There is an epidemic of childhood and adolescent obesity in the United States. In many of these cases, a premature metabolic disorder is induced by poor diet, genetic predisposition, and sedentary lifestyle. Relatively simple steps that induce a healthy metabolic profile can correct many of the causes of obesity in younger people.

Hyperinsulinemia (too much insulin in the blood) is one of the culprits in the obesity epidemic today. According to some popular diet books, one way to reduce excess insulin is to eat a low-glycemic diet. Authors of these books advocate that obese people should avoid foods that induce the pancreas to over-secrete insulin. In reading the many diet books that extol the role of high-glycemic foods in causing weight gain, one is led to believe that it is an absolute fact that individuals become overweight because they consume too many of the wrong kinds of (high-glycemic) food or drink. However, a review of the published scientific literature reveals contradictions in the hypothesis that an obese individual can switch to a low-glycemic diet and obtain meaningful body fat loss. Some studies show no weight loss in individuals consuming low glycemic rather than high glycemic diets (Astrup et al. 2002). Other studies report moderate weight loss benefits to those consuming lower glycemic diets ( et al. 1999; Brand- et al. 2002).

The only way to reverse obesity is to correct the multiple metabolic disorders that induce the body to store ingested calories as fat rather than to burn them as energy. By failing to alter an individual's biochemistry, severely overweight people suffer through agonizing diets, only to attain mediocre or no fat loss results.

The Forgotten ScienceThis Obesity protocol has been written to address the failure of both conventional and alternative medicine to develop a program for inducing sustained fat loss in obese individuals.

In reviewing medical works published in the 1960s and 1970s, it is apparent that great progress was being made toward discovering the specific underlying metabolic abnormalities that cause excess fat gain (Bray 1969). Today however, one of these same medical works (Cecil-Loeb Textbook of Medicine) omits this crucial information. The premises espoused in the early textbook have by no means been refuted--they have only been forgotten. For example, an early work revealed the mechanism by which normal, non-obese people handled excess calories--without gaining weight--and also provided a giant step toward developing meaningful obesity treatment modalities (Bray 1969). By itself, an increased understanding of the role of insulin in storing excess fat (Felig et al. 1969) should have ended use of today's flawed "diet" concept. These early works emphasized that an individual cannot mobilize fat from storage if insulin is present in the blood--and if an individual is overweight, insulin levels are elevated.

Physicians today are largely unaware of these long-ago established facts. The result is that they treat diseases associated with obesity (cardiovascular, cancer, diabetes, cartilage breakdown), but do not effectively treat obesity itself. Physicians tell obese patients to eat less and exercise more; yet the obesity epidemic worsens every year. This protocol will present the forgotten science and combine it with breakthrough approaches that have never been utilized outside a small clinical setting.

FIBER

The Search for a Better Fiber Using the Most Viscous Fibers

Soluble fiber includes pectin, gum, and mucilage. Soluble fiber tends to form a gel when added to water. Soluble fiber is found in oat bran, barley, vegetables (carrots), and fruits (apples and oranges). Insoluble fiber is made from cellulose that is used primarily as structural material in plants. Insoluble fiber functions to increase the bulk of stools.

A study examined the use of fiber in a weight-loss program: 53 moderately overweight females (BMI >27.5 kg/m2) on reduced energy intake (1200 kcal/day) were treated for 24 weeks with a fiber supplement on a random, double-blind, placebo-controlled basis. The fiber was administered as an initial dose of 6 grams and a maintenance dose of 4 grams. After treatment, mean weight loss in the fiber group was 8.0 kg (17.6 pounds) versus 5.8 kg (12.76 pounds) in the placebo group (Birketvedt et al. 2000).

A review of published studies on the effects of dietary fiber on hunger, satiety, energy intake, and body composition in healthy individuals found that under conditions of fixed energy intake, the majority of reports indicate that an increase in either soluble or insoluble fiber intake increases post-meal satiety (sensation of fullness) and decreases subsequent hunger. When energy intake is not restricted, mean values from published studies indicate that consumption of an additional 14 grams per day of fiber for more than 2 days is associated with a 10% decrease in energy intake and body weight loss of 1.9 kg over 3.8 months. The observed changes in energy intake and body weight occur both when the fiber is from naturally high-fiber foods and when it is from a fiber supplement. The authors concluded that increasing dietary fiber intake to at least the minimum recommended by the American Heart Association (25-30 grams per day) may help to decrease the currently high national prevalence of obesity (Howarth et al. 2001).

The best time to take fiber is with the highest-fat meal of the day. The objective is to have the fiber absorb some of the dietary fat to prevent it from absorbing into the bloodstream where it helps contribute to body fat accumulation. Do not take fiber at the same time you take beneficial fatty acids such as CLA, EPA/DHA, and GLA. The fiber can absorb these critically important fatty acids before they can reach your cells. Some people experience unpleasant gastrointestinal side effects when taking high doses of fiber. It is best to begin with a very low dose, increasing the dose slowly. Fiber supplements consisting of guar gum, pectins, and psyllium seed husks are available in capsule form and in powder that can be mixed in liquid and consumed immediately before eating a fatty meal.

The Search for a Better FiberScientific studies consistently document the ability of water-soluble fibers to inhibit carbohydrate absorption, reduce cholesterol and low-density lipoprotein (LDL), and induce some weight loss (Marlett 2002, 2002). When taken before meals, these fiber sources bind to water in the stomach and small intestine to form a gelatinous, viscous mass that slows the absorption of sugars and inhibits the re-absorption of intestinal cholesterol excreted from the liver. The net effect is a reduction in the number of absorbed calories and an induction of a feeling of satiety.

The problem until now is that the large quantity of fiber required to produce a meaningful effect has resulted in poor compliance, primarily because of upper and lower gastrointestinal-related discomfort.

In the early 1990s, scientists at the University of Toronto began to investigate a novel class of viscous fibers in order to identify a low-dose blend that would reduce blood glucose, insulin, cholesterol, and LDL levels. Initial studies confirmed the beneficial effects of these soluble fibers. Compared to placebo, those consuming highly viscous fibers before meals showed improvement in glycemic control, blood lipid levels, and blood pressure (Vuksan et al. 1999, 2000) The problem, however, remained—these beneficial effects could be produced only by ingesting large amounts of this fiber.

To overcome this problem, the scientists tested hundreds of different fiber blends with the objective of achieving significant benefits from only a few grams of soluble fiber per meal.

One of the initial findings that motivated the University of Toronto scientists to pursue this research occurred during a study that measured the glycemic-index response to different forms of fiber (or no fiber). In this study, three grams of various fibers were administered prior to a 20-gram glucose challenge. As expected, the glycemic index of the control group receiving no fiber was 100. Those receiving three grams of psyllium and xanthan showed only negligible glycemic index reductions (3% and 6%, respectively). By contrast, test subjects receiving three grams of a novel fiber blend showed a remarkable 39% reduction in their glycemic index. This finding demonstrated that consuming just three grams of this highly viscous fiber before a meal could significantly reduce the number of insulin-spiking carbohydrate calories absorbed (Kim et al. 1996).

Using the Most Viscous FibersGlucomannan possesses the greatest viscosity (gelling property) of all known soluble fibers (Kim et al. 1996; et al. 2004).

Four to five grams of glucomannan blended into fluid or mixed with food can slow carbohydrate absorption into the bloodstream and dampen the ensuing insulin spike by up to 50% (Kim et al. 2002). Controlled clinical studies document that glucomannan can promote satiety and induce modest weight loss (Walsh et al. 1984; Vitamin A et al. 1992; Cairella et al. 1995; Liviera et al. 1992). It has been shown to significantly lower LDL and total cholesterol, improve diabetic control, and correct constipation (Bell 2001; Ceriello 2004; Lebovitz 2001; Marlett et al. 2002; et al. 2002; Vuksan et al. 2000; Vuksan et al. 1999; Kim et al. 1996; et al. 2004; Walsh et al. 1984; Vitamin A et al. 1992; Cairella et al. 1995; Livieri et al. 1992).

The reason glucomannan has fallen by the wayside is that in the 1980s, programs promoting quick weight loss advertised glucomannan as a supplement that could make obese people thin. The FTC stepped in and aggressively attacked those who were making exaggerated fat-loss claims for glucomannan. The subsequent negative reports by the news media caused glucomannan to be viewed by the public as a worthless dietary supplement.

THE GLYCEMIC INDEX

Studies Confirm Effectiveness Novel Fiber Limits Sugar Absorption

The glycemic index is a way of calculating the rate by which blood glucose levels rise in response to different food types, with pure glucose producing a reading of 100. The glycemic index measures how fast a particular food triggers a spike in blood glucose. Higher-glycemic foods prompt an elevated insulin release because the pancreas is stimulated to metabolize the sudden surge of glucose into the blood.

The published scientific studies on glucomannan, however, are quite impressive. Although it does not make fat people thin, a double-blind trial showed that compared to placebo, obese subjects taking one gram of glucomannan before each meal lost 5.5 pounds after only eight weeks (Walsh et al. 1984). The subjects were instructed not to change their eating or exercise patterns. Total cholesterol and LDL also were reduced (by 21.7 and 15.0 mg/dL, respectively) in the glucomannan-supplemented group. No adverse reactions to glucomannan were reported.

Several other published studies confirm that glucomannan modestly reduces weight compared to placebo or diet alone (Vita et al. 1992; Cairella et al. 1995; Livieri et al. 1992). Total cholesterol and LDL, along with after-meal insulin and glucose blood levels, are significantly reduced when glucomannan is taken before meals (Vita et al. 1992; Cairella et al. 1995; Livieri et al. 1992).

With this knowledge of glucomannan as a foundation, University of Toronto scientists led by Vladimir Vuksan, PhD, combined glucomannan with two other viscous fibers (xanthan and alginate) in an exact ratio to increase the viscosity of the original glucomannan material by 2.5-5 times (Vuksan). A mulberry concentrate (20:1) was added to enhance the glycemic-control and lipid-lowering effects (Andallu et al. 2001).

The primary benefit of this proprietary fiber blend lies in its superior viscosity. This means that it is better able to expand in the gastrointestinal tract to inhibit sugar absorption and bind cholesterol. This enables much smaller quantities to be taken than of other viscous dietary fibers to achieve comparable health benefits. The fiber blend’s trade name is PGXâ„¢, which stands for “polyglycoplex.â€

Studies Confirm EffectivenessAt last June’s 64th Annual Meeting of the American Diabetes Association, held in Orlando, FL, the results of two studies using the PGX™ fiber blend were presented by researchers from the Risk Factor Modification Centre at St. ’s Hospital and the University of Toronto (Vuksan et al. 2004). The first study reported on test subjects who took three grams of the fiber blend, followed by a huge 50-gram acute glucose challenge. Compared to the control group, those taking the fiber blend had a 65% reduction in postprandial glucose elevation.

The second study was performed over a three-week period to better reflect real-life experiences. Study subjects took three grams of the fiber blend three times a day before meals. After three weeks, there was a 23% reduction in postprandial glucose, a 40% reduction in after-meal insulin release, and a 55.9% improvement in whole-body insulin sensitivity scores. In addition, this proprietary fiber blend reduced body fat by 2.8% from baseline by the end of the three-week study period.

As a result of these findings, a large, longer-term clinical study has been initiated to further evaluate this unique fiber blend’s effects on weight loss.

Novel Fiber Limits Sugar Absorption

Using Fiber to Aid Weight LossCritics have attacked the use of fiber supplements because they are not a cure for obesity. While this is true, clinical findings reveal that ordinary fiber supplements can reduce the number of calories consumed by 30 to 180 calories per day (Vuksan et al. 2004). While modest, this reduction in calorie absorption would, over the course of a year, result in a weight loss of 3-18 pounds (Murray 2003).

The PGXâ„¢ high-viscosity fiber blend may provide better results than ordinary fibers used in previous studies. Clinical studies have repeatedly shown that after-meal blood sugar levels decrease as soluble fiber viscosity increases ( et al. 2002; et al. 2000). This relationship has also been shown with improved weight control and diminished appetite (Walsh et al. 1984; Vita et al. 1992; Cairella et al. 1995; Livieri et al. 1992). We are anxiously awaiting the results of the ongoing weight-loss study of PGXâ„¢.

In the meantime, however, the dramatic effects shown by the PGXâ„¢ fiber blend in reducing insulin, glucose, LDL, and total cholesterol make it a common-sense supplement to take before meals. Any reduction of calorie absorption should benefit overall health. Taking steps to reduce excess insulin secretion may help protect against a wide range of degenerative processes.

Fiber: Limits to Weight LossWith all the books that have been written about the obesity-inducing effects of excess insulin, one would think that weight loss would automatically occur in response to a lowered intake of high-glycemic foods combined with a high intake of soluble fibers.

The problem is that age-associated weight gain is a multifactorial process that can be only partially addressed with existing approaches. This protocol on obesity describes why it is difficult for people to lose significant amounts of body fat. There is help on the way, but the total solution in a pill is not yet here.

In the meantime, Life Extension recommends that people seeking to lose weight consume a high fiber diet, particularly PGXâ„¢ highly viscous fiber blend 1000-3000 mg 5-10 minutes before each meal with 8-16 ounces of water.

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Obesity

THYROID DEFICIENCY AND WEIGHT GAIN

Thyroid Blood Tests Assessing Thyroid Function without Blood Tests

Overweight people often starve themselves all day long and then snack late into the night--a perfect formula for weight gain! As already noted, the American Journal of Clinical Nutrition reported an elegant study proving that food eaten early in the day generates more energy (diet-induced thermogenesis) than does food eaten later in the day (Weststrate 1993).

When some individuals first try eating in the morning, they often find that they are not hungry. Some physicians have suggested that these individuals force themselves to eat in the morning to re-regulate the eating schedule toward consuming a majority of calories early in the day. If you over consume high-glycemic foods, including sugar-laden desserts, do so for breakfast when the thermogenic (energy-burning) rate is the highest.

There are serious misconceptions about why people accumulate so much body fat as they age. One overlooked factor is that aging people have startlingly high levels of insulin in their blood. When the blood is saturated with insulin, the body will not release significant fat stores, even when a person restricts their calorie intake and exercises.

Other factors are also responsible for today's obesity epidemic. When an individual's hormones are out of balance, it may be impossible to achieve sustained weight management. Even when blood tests reveal "normal" thyroid hormone status, there is often an inability to convert T4 thyroid hormone into T3, which is necessary for natural thermogenesis (fat burning) to occur. T3 deficiency is another hormonal reason why excess weight accumulates with aging.

Additionally, if testosterone and/or estrogen levels are out of balance, excessive fat gain is often the result. (Very safe drugs and nutrients are available to correct these obesity-inducing hormone imbalances.)

As already stated, we tend to put on weight as we grow older, in part because aging impairs our ability to metabolize carbohydrates. Because most foods, besides fats, are eventually broken down into glucose (blood sugar), a decline in our ability to metabolize glucose is a significant cause of degenerative disease and the excessive weight gain associated with aging. One cause of impaired carbohydrate metabolism is subclinical thyroid deficiency.

Blood tests are not always reliable to diagnose subclinical thyroid deficiency. A study found that 14% of elderly people who were initially diagnosed as having normal thyroid levels were later found to have significant thyroid deficiency after undergoing extensive testing. Some physicians believe that most people over 40 have a subclinical thyroid deficiency that contributes to their weight gain (Bemben et al. 1994; s 1998).

The thyroid gland secretes hormones involved in cellular energy expenditure. When an individual diets, the enzyme 5-monodiiodinase that is necessary to convert the thyroid hormone T4 into metabolically active T3 is reduced. T3 deficiency results in a slowing down of the body's metabolic rate and less food is metabolized to energy. This decrease in metabolic rate occurs because your body thinks you are starving and tries to conserve energy until more food is found.

Most of those who diet know about the "rebound effect"--the body resists losing weight while you "starve yourself," but then puts the weight back on with devastating speed when you begin to eat a little more. This is why dieting is such a miserable way to try to lose weight. But now you know why--it is because low T3 levels impair metabolic reactions by reducing your energy production and keeps you from losing weight. This biological mechanism involving thyroid hormone conversion, evolved over hundreds of thousands of years to counter starvation, is a sabotaging factor even when you deliberately eat less in an attempt to lose weight.

To illustrate how thyroid hormone status dictates body weight, consider the fact that when the thyroid produces too much thyroid hormone, the most common clinical symptom is significant weight loss. Hyperthyroidism is the name of the condition caused by an overactive thyroid gland. In 76-83% of cases, patients' first complaints to their physician are about how much weight they have lost.

On the other hand, clinical studies have shown that dieting produces a decline in the conversion of T4 to T3, resulting in a severe reduction in resting energy expenditure. This reduced metabolic rate prevents cells from burning calories to produce energy. If the cells do not take up glucose to produce energy, sugar is stored as fat within the body. The only way dieting can produce significant long-term weight loss is for the cells to take up glucose for conversion into energy rather than into body fat. When the flow of glucose is reversed from conversion into fat and storage in fat cells it is then necessary for the fat cells to release fatty acids for energy production. This is why thyroid hormone supplementation is so important to many people seeking weight loss through dieting. Not only does thyroid hormone replacement maintain healthy thermogenic activity, but it helps fight fatigue, depression, and other common disorders associated with calorie restriction. Individuals who have thyroid hormone deficiency should be prescribed a drug such as Cytomel or Armour (only under supervision of a physician).

While there are studies showing that thyroid supplementation promotes weight loss in some individuals, thyroid supplementation should only be used when there is evidence of a thyroid hormone imbalance due either to decreased secretion from the thyroid gland or decreased conversion of T4 to the more metabolically active T3 in the peripheral tissues. It is important to remember that as the body attempts to slow the metabolic rate to conserve body mass, many individuals become thyroid deficient in response to dieting. This is the normal response of the body to caloric restriction, a condition that prompts conservation of energy by inhibition of general metabolism.

Therefore, an individual with normal thyroid status before dieting may become thyroid deficient as a result of reduced intake of calories. For optimal fat-loss effects, an individual may require Cytomel or Armour drug therapy if they expect that eating fewer calories will result in significant long-term weight control.

In summary, thyroid hormones increase the metabolic rate of the entire body by accelerating the rate at which all energy sources are burned for energy and for heat. This is particularly important in Northern or colder climates. Thyroid hormones literally uncouple the metabolic processes that burn sugar and fat for the production of ATP, the energy currency of the body. ATP is a stored form of energy because it can later enter into reactions that transfer this energy to other bodily processes. Thyroid hormones uncouple the conservation of energy as ATP as fats and glucose are burned by allowing the released energy to be dissipated as heat rather than stored as ATP. Think of the role of thyroid hormones as conservers of energy. This function is useful to prevent eventual death due to starvation because it allows one to survive longer upon available stores of predominantly fat, while conserving glucose for those key organs that can only survive on glucose, such as the brain, kidney cortex, and red blood cells (at least initially for the brain). On the other side of the coin, release of thyroid hormones in cold environments prevents an early death due to freezing by accelerating the burning of predominantly fat (and some glucose) for energy production as heat.

The unifying principle here, and the fact most pertinent to the dieter trying to lose body fat, is that the body will almost always favor the burning of glucose over fat as long as there is a surplus of glucose. Fat is only burned when it is necessary to spare glucose. This is mainly due to the fact that glucose burns very cleanly and efficiently in all tissues, whereas, the utilization of fat requires the continual input of energy before fat can be burned. Another key fact is that fat can never be converted into glucose and the body’s ability to store glucose as glycogen is very limited. Consequently, the body can store a hundred-fold higher amount of energy as fat than as glucose or glycogen. This is why fat is conserved for times when glucose supply is threatened. The dieter that can reduce carbohydrate intake long enough so as to drop blood glucose levels will trigger many hormonal reactions to increase the burning of both fat and excess protein. This is done predominantly through the release of adrenaline, which directly releases fatty acids into the blood from fat cells, and through release of adrenal glucocorticoids that accelerate the rate of conversion of fat and protein into glucose. In time, such as during prolonged starvation, the rate of protein catabolism is slowed and the body for the most part is running on fat metabolism for energy, while the catabolism of protein continues primarily to enable the synthesis of glucose for a small set of tissues that can not survive on fatty acids or other fatty acid intermediates.

Thyroid Blood TestsThere are several blood tests to assess thyroid function. If any of these tests indicate a thyroid deficiency, a physician should consider prescribing the appropriate dose of the drugs Cytomel (T3) or Armour desiccated thyroid to bring the level into the normal range.

If an individual's blood test shows an increase in thyroid stimulating hormone (TSH), this means that the pituitary gland is over secreting a hormone to stimulate thyroid function because of an apparent thyroid deficiency. The normal range for TSH can be as wide as 0.2-5.5 mU/mL. However, if TSH levels are above 2.0, this indicates that the individual may be hypothyroid and could benefit from Cytomel or Armour drug therapy. Remember, the higher the range of TSH, the more likely you are to be thyroid deficient. This relative thyroid deficiency predominantly prevents the excess calories consumed from being burned for energy.

A T4 (or total thyroxine) test measures the actual hormone being secreted by your thyroid gland. If T4 is deficient, most physicians will prescribe Synthroid, which is a synthetic T4 hormone. However, we recommend Cytomel (T3) or Armour desiccated thyroid instead of Synthroid (T4) because T3 is the more metabolically active form of thyroid that aids in thermogenesis (body fat burning). When evaluating T4 blood test results, the optimal range for males seeking to lose weight should be in a range of 8.5-10.5. Females under age 60 seeking to lose weight should be in the range of 9-11 mcg/dL. Women older than 60 years should be in the range of 8.5-10.7 mcg/dL. Too much T4 is a sign of hyperthyroidism that should receive immediate medical treatment (Tietz 1995).

Measuring the level of T3 (triiodothyronine) is one way to ascertain how much metabolically active thyroid hormone is available to the tissues. Normal T3 range is 2.3-4.2 pg/mL, but to lose weight, consider being in the range of 3.2-4.2 pg/mL. If levels are below this, Cytomel drug therapy is recommended. Most individuals begin at 12.5 mcg of Cytomel twice a day. The dose can be increased if blood T3 levels do not return to a normal range or if symptoms of thyroid deficiency persist. If T3 levels are above normal, this can indicate an overdose of drugs such as Synthroid or Cytomel or suggest hyperthyroidism.

A less frequently used blood test to assess thyroid function measures thyroglobulin (normal range, 1-20 ng/mL). If thyroglobulin is decreased, hypothyroidism is indicated. Another less commonly used blood test to assess thyroid function measures thyroid-binding globulin (normal range, 21-52 mcg/dL). If thyroid-binding globulin is increased, the individual is usually deficient in thyroid function (hypothyroid).

Assessing Thyroid Function without Blood TestsSome physicians say it is more accurate to assess thyroid function by measuring body temperature in the morning before getting out of bed. This method, known as the Basal Temperature Chart, is believed to be especially useful in the treatment of obesity.

Every morning, as soon as awakening, before getting out of bed, put a thermometer under your tongue and let it remain there for three (3) minutes.

If your under-the-tongue temperature is less than 97.8-98.2 degrees Fahrenheit, you are likely hypothyroid. To get the most accurate results, repeat this test every day for at least 2 weeks. Write down the date, time, and temperature and bring this with you when you go to your weight-loss physician. Chronic morning basal temperature readings below 97.8-98.2 might indicate a need for thyroid hormone replacement.

In summary, as we age the thyroid gland releases less thyroid hormone. This facilitates conservation of energy so the same amount of calories consumed now result in energy storage as fat. This duplicates the textbook function of insulin in that insulin is regarded as the hormone of storage. Insulin stores energy in the form of fat and glycogen.

OTHER HORMONE IMBALANCES

DHEA Testosterone Deficiency and Abdominal Obesity in Men A Scientific Approach for Inducing Fat Loss How to Correct Hormone Imbalances Discovered by Blood Testing

DHEAWe know that hormone imbalances (such as too much insulin, too little T3, etc.) are a cause of age-associated weight gain. The adrenal hormone dehydroepiandrosterone (DHEA) has kept old animals remarkably thin, but has not worked as well in humans. Nevertheless, many older individuals taking DHEA report anabolic muscle gain and fat loss. DHEA has been shown to boost insulin growth factor (IGF-1) in humans, and the increase in this youth factor may be responsible for the fat reduction and anabolic effects seen in some elderly people.

In individuals with low thyroid hormone output (hypothyroid), DHEA levels are low (Tagawa et al. 2000, 2001). For some, DHEA replacement could help protect against the decline in thyroid hormone output that occurs in response to reduced calorie intake.

For people over 35 year of age, the benefits of restoring DHEA levels to a youthful state include immune enhancement, protection against neurological disease, reductions in risks of cardiovascular disease, alleviation of depression, and protection against osteoporosis.

DHEA-replacement therapy is also suggested as part of an overall weight-management program for people over 35 years of age. The average daily dose of DHEA for men is 50 mg of DHEA, whereas women need only 15-50 mg. It is advisable to take DHEA early in the day.

Refer to the DHEA Replacement Therapy protocol before taking DHEA. DHEA is contraindicated in men and women with hormone-related cancers.

Testosterone Deficiency and Abdominal Obesity in MenA consistent finding in the scientific literature is that obese men have low testosterone and very high estrogen levels. Central or visceral obesity (pot belly) is recognized as a risk factor for cardiovascular disease and type II diabetes. Boosting testosterone levels decreases the abdominal fat mass, reverses glucose intolerance, and reduces lipoprotein abnormalities in the serum. Further analysis has also disclosed a regulatory role for testosterone in counteracting visceral fat accumulation. Longitudinal epidemiological data demonstrate that relatively low testosterone levels are a risk factor for development of visceral obesity (Tenover 1992; Marin et al. 1998).

In one group of morbidly obese men, a study showed that serum estrone and estradiol were elevated twofold. Fat cells synthesize the aromatase enzyme, causing male hormones (testosterone and others) to convert to estrogens (Deslypere et al. 1985). Fat tissues, especially in the abdomen, have been shown to "aromatize" (convert) testosterone and its precursor hormones into potent estrogens (Schneider et al. 1979; Kley et al. 1980a,b; Killinger et al. 1987; Khaw et al. 1992; Marin et al. 1992, 1998).

Eating high-fat foods may reduce free testosterone levels according to one study that measured serum levels of sex steroid hormones after ingestion of different types of food. High-protein and high-carbohydrate meals had no effect on serum hormone levels, but a fat-containing meal reduced free testosterone levels for 4 hours (Killinger et. al. 1987).

Obese men experience testosterone deficiency caused by the production of excess aromatase enzyme in fat cells and also from the fat they consume in their diet (Khaw et al. 1992). The resulting hormone imbalance (too much estrogen and not enough free testosterone) in obese men partially explains why so many are impotent and experience a wide range of premature degenerative diseases (Blum et al. 1988).

Clinical findings have shed light on subtle hormone imbalances of borderline character in obese men that often fall within the normal laboratory reference range (Shippen et al. 2001). This means that if you are a man over age 40 and your physician tells you that your testosterone and estradiol are "normal," your levels are normal for a person of your age. It does not necessarily mean that your actual levels of testosterone/estrogen are in optimal, youthful ranges that would help to induce fat loss, especially in the abdomen. For complete information on boosting free testosterone and suppressing excess estrogen, refer to the Male Hormone Modulation Therapy protocol. Men contemplating testosterone replacement therapy should have a PSA blood test and digital rectal exam to rule out existing prostate cancer.

A Scientific Approach for Inducing Fat LossPeople seeking to lose weight should have their blood tested to determine obesity-related factors such as insulin, glucose, thyroid, testosterone, and estrogen.

The following chart reveals the most important blood tests that can help you and your physician facilitate optimal weight loss. It shows the hormone imbalances often seen in corpulent individuals compared to healthy ranges enjoyed by normal weight people.

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Obesity

How to Correct Hormone Imbalances Discovered by Blood TestingOnce blood testing results are received, a hormone-modulating program can be tailored to fit a person's individual profile. For instance, if there is any indication of thyroid deficiency, take the appropriate thyroid replacement medication (usually Cytomel). Starting dose of Cytomel is normally 12.5 mcg twice a day. Because reducing calorie intake may cause thyroid deficiency, have your blood tested every few months or use the morning basal temperature test to make sure that you do not need a thyroid replacement drug.

If DHEA levels are low (they almost always are in people over age 35), take the appropriate amount of DHEA (15-50 mg/day) to restore them to a youthful range. Stop eating after 6:30 p.m. and alter your diet by reducing consumption of high glycemic index foods.

Range often seen in overweight and obese individuals

Healthy range (where you want to be)

Thyroid panel

TSH

2.0-5.5 mcIU/mL

0.40-2.0 mcIU/mL

Free T3

2.3-4.2 mcIU/mL

(Upper half of range)

T4

4.5-12.0 mcg/dL

(Upper half of range)

Fasting insulin

20-60 mcIU/mL

0-5 mcIU/mL

DHEA

Men

40-200 mcg/dL

400-560 mcg/dL

Women

30-150 mcg/dL

350-430 mcg/dL

Free testosterone*

Men

Quest

40-100 pg/mL

150-210 pg/mL

LabCorp.

5-12 pg/mL

18-26.5 pg/mL

Women

0.0-0.9 pg/mL

1.0-2.5 pg/mL

Estradiol

Men

30-90 pg/mL

10-30 pg/mL

Postmenopausal women

50-150 pg/mL

The lowest amount needed to be symptom-free (Postmenopausal women who are not taking estrogen drugs are normally around 30 pg/mL.)

Progesterone:

Postmenopausal women

0.0-0.7 ng/mL

>2.0 ng/mL

Pre-menopausal women

Amount can vary from 0.2-28.0 ng/mL during the cycle. Use time of cycle to ascertain deficiency.

Complete Blood Chemistry (CBC)

To include blood counts, liver enzymes, and glucose.

PSA

Men should have a PSA test to help rule out prostate cancer.

*Reference ranges for determining free testosterone vary depending upon the assay technique used for analysis. Quest Diagnostics employs the following reference values to determine free testosterone: adult males (20-60+ years), 50-210 pg/mL; optimal values for aging men without prostate cancer, 150-210 pg/mL; adult females (premenopausal), 1.0-8.5 pg/mL; adult females (postmenopausal), 0.6-6.7 pg/mL. When testing for free testosterone, be certain you know and understand the analytical method used.

In men, if free testosterone is below the optimal range, ask your physician to prescribe a transdermal cream providing 5 mg a day of natural testosterone. If estradiol levels are high (over 30), use 0.5 mg of the drug Arimidex twice a week to block the aromatase enzyme that converts testosterone to estrogen. Before using testosterone, men should verify that they do not have prostate cancer by having a blood test for PSA and undergoing a digital rectal exam.

Unlike in men, balancing estradiol levels in women is complicated and individualistic. Overweight women often have high estradiol levels because fat cells produce the aromatase enzyme that causes the body to make more estrogen. Liver function is very important in the metabolism of estrogens. If estrogen cannot be conjugated properly, it will not be excreted normally and levels will remain high. Cattle are implanted with estrogen pellets to "fatten" them up. A common complaint by women taking estrogen drugs is weight gain. Women should seek to modulate their estrogen levels, but should do so under the supervision of a physician with expertise in female hormone modulation.

Concerning estrogen, testosterone, and progesterone modulation in women, modulation has to be precisely carried out to induce weight loss without encountering unpleasant side effects such as hot flashes and depression. The general relation of progesterone to estradiol in healthy women is around 10:1 or higher. Below that a woman can become "estrogen dominant." In this situation, estrogen dominates the effects of the testosterone and progesterone. This is especially prevalent in overweight women because the fat cells induce excess estrogen, which creates a vicious cycle that should be broken to restore optimal hormone balance. Physicians often first try to raise testosterone and progesterone to offset the excess estrogen. If that does not help negate the effects of estrogen dominance, the next step is to try to lower estradiol. This must be done under a physician's supervision because it involves drugs (such as Arimidex) and must be done carefully to avoid unpleasant side effects. A woman with an estradiol value of 200 pg/mL would need 2000 pg/mL (2.0 ng/mL) of progesterone to offset it. Extra progesterone does no harm and most women like the feeling of having higher progesterone levels. Sometimes DHEA and testosterone supplementation can convert to estradiol, so that must be considered also.

Once you have achieved a youthful hormone profile, along with supplements that help facilitate weight loss, you are in a position to determine how much body fat you want to lose. There may be social occasions when you do not want to curb your appetite because you want to eat a big meal. You will find it easy to make healthy food choices such as including more fresh fruits and vegetables in your diet, avoiding high sugar snacks, and reducing total calorie intake.

Hormone modulation is the only practical approach for most aging individuals to rid their body of excess body fat and keep it off. If you are seriously concerned about protecting yourself against multiple degenerative diseases while improving your appearance, you should have your blood tested. Once the results are received, modulate your hormone profile accordingly by taking the drugs and supplements that can help restore youthful fat-muscle ratios. If you need a referral to a physician knowledgeable about hormone modulation, please call .

FAT-LOSS SUPPLEMENTS

The Fat-Reducing Effects of Conjugated Linoleic Acid

As you have been reading, it is virtually impossible to achieve a sustained reduction in body fat without hormone modulation. If postprandial insulin is high, it must be suppressed. If thyroid hormone status is low, it must be brought back to normal. Estrogen, testosterone, and DHEA should be restored to youthful ranges.

In addition to correcting a hormone imbalance that may be the underlying cause of unwanted weight gain, certain dietary supplements can help facilitate and sustain fat loss. These low-cost supplements should be used in addition to physician-supervised hormone modulation therapy.

The Fat-Reducing Effects of Conjugated Linoleic AcidConjugated linoleic acid (CLA) is a fatty acid component of beef and milk that has been shown to reduce body fat in both animals and humans. CLA is essential for the transport of dietary fat into cells, where it is used to build muscle and produce energy. Fat that is not used for anabolic energy production is converted into newly stored fat cells.

The primary dietary sources of CLA are beef and milk, but Americans are eating less beef and drinking less whole milk in order to reduce their dietary intake of saturated fat. People often drink nonfat milk, but it is the fat content of milk that contains CLA. Because skim milk contains virtually no CLA, persons seeking to lose weight who also drink skim milk are depriving themselves of a potential source of this fat-reducing nutrient.

In 1963, the CLA percentage in milk was as high as 2.81%. By 1992, the percentage of CLA in dairy products seldom exceeded 1%. The reason for the sharp reduction in milk CLA was because of changing feeding patterns. Cows that eat natural grass produce large amounts of CLA. Today's "efficient" feeding methods rely on far less natural grass. For example, grass-fed Australian cows have three to four times as much CLA in their meat as do American cows.

However, health-conscious Americans avoid beef and whole milk because these foods are high in fat, and when people do consume beef or milk, they are consuming very little CLA because of the deficiency of CLA in cows today. Thus, most Americans have inadequate amounts of CLA in their diet. This CLA deficiency might be at least partially responsible for the epidemic of overweight people of all ages that now exists.

HOW BODY FAT ACCUMULATES

CLA Fat-Loss Studies Preventing Cancer While Losing Weight How CLA Induces Fat Loss The Safety of CLA

Excess body fat accumulates via two distinct mechanisms. People either form more adipocytes (fat cells) and/or existing adipocytes absorb too much fat and become larger. The effect of too many adipocytes and/or "bloated" adipocytes is the unsightly and unhealthy amassing of body fat.

Conjugated linoleic acid (CLA) has been shown to decrease the volume of adipocytes and thus reduce body fat (Park et al. 1997, 1999). However, many overweight people have too many adipocytes (fat cells). These people need more than CLA to achieve effective weight control.

At the Experimental Biology 2002 meeting (New Orleans, Louisiana, April 19-24, 2002), scientists presented a fascinating study in which a group of mice was supplemented with CLA or CLA plus guarana. After 6 weeks, both groups of mice showed a substantial reduction in fat mass. In the CLA-only group, the decrease in fat mass was due to dramatic reduction in adipocyte size without a change in adipocyte number. In the CLA plus guarana group, both adipocyte size and number were reduced by 50% (FASEB 2002). The results of this study demonstrate that dietary CLA decreases excess fat accumulation by reducing the capacity of adipocytes to store fat. When guarana is added to CLA, there is an additional effect of reduction in adipocyte number and a decrease in adipocyte size. The impact of this finding in preventing obesity is profound.

CLA Fat-Loss StudiesIn July 1996; The Life Extension Foundation introduced CLA to its members. At the time of launch, numerous published studies had already detailed this nutrient's anti-cancer effects. What had impressed scientists was the fact that only relatively small amounts of CLA (3-4 grams per day) were required to achieve all of its wonderful effects.

In weight-loss studies, CLA consistently shows an ability to reduce body fat while maintaining lean muscle mass. In one study, mice fed the human equivalent of 3000-4000 mg a day of CLA achieved a 60% reduction in body fat and a 14% increase of lean body mass (Terpstra et al. 2002). Another study conducted at Louisiana State University reported up to an 88% reduction in the body fat of male mice fed CLA--after only 6 weeks (West et al. 1998).

A particularly significant study entitled "Dietary Conjugated Linoleic Acids Increase Lean Tissue and Decrease Fat Deposition in Growing Pigs" was reported in the November 1999 issue of The Journal of Nutrition (Ostrowska et al. 1999). The key element of the study was confirmation that CLA is able to decrease fat storage and maintain lean muscle tissue. In this study, researchers used young female pigs to illustrate the effects of combining a relatively small amount of CLA with the normal diet of the pigs. Because pigs have organs and metabolism similar to humans, they are good experimental models of human nutrition. Sixty pigs were randomly placed in one of six dietary treatments; one was the control group that received no CLA. Each other group received one of five different concentrations of CLA added to the feed. The pigs had free access to water and their diet at all times (2 kilograms of food per day).

After only 4 weeks of CLA supplementation, there was significantly less fat and leaner tissue in the groups receiving the CLA. After 8 weeks, the pigs with the highest CLA supplementation showed a 31% loss of body fat and a 5% increase in lean tissue. In addition, at the highest level of CLA supplementation, the back fat depth was reduced by 25%. This study was the first to show the profound effects of CLA supplements on the composition and deposition of body fat, in relation to protein, water, and other tissues of pigs (Ostrowska et al. 1999).

A study in The International Journal of Obesity concluded that CLA reduced abdominal fat among men classified as abdominally obese (Riserus et al. 2001). The study participants taking CLA lost an average of 1.4 cm in waist circumference after only 4 weeks. This double-blind, randomized, placebo-controlled trial observed 25 men with significant abdominal fat for 4 weeks: 14 received 4.2 grams of CLA per day, while the others received placebo. At the conclusion of the study, there was a significant decrease of abdominal diameter in the CLA group. None of the study participants changed their eating or exercise habits during the trial period (Riserus et al. 2001).

Results of the Riserus et al. (2001) study supported data published in the December 2000 issue of The Journal of Nutrition. That study concluded that CLA reduced body fat and preserved muscle mass among the 60-person study group. Participants lost an average of 6 pounds while taking CLA (Blankson et al. 2000).

CLA is a unique supplement because not only does it guard against serious diseases, but it is also an effective tool for one of the most serious conditions affecting Americans--obesity. As more and more Americans join the ranks of the overweight, millions more start diets that are usually destined to fail.

Preventing Cancer While Losing WeightCLA is not just for fat loss. Studies show CLA may also help protect against many diseases including atherosclerosis and cancer.

In an article appearing in The Journal of Nutrition, significant cancer-preventing properties were shown when CLA was added to the diet (Ip et al. 1999a). The study revealed that CLA was a "potent cancer preventative agent in animal models." Specifically, it was determined that feeding CLA to female rats while they were young and still developing conferred life-long protection from breast cancer. This preventive action was achieved by adding only enough CLA to equal 0.8% of the animal's total diet. This compares favorably with Life Extension's recommendation of 3000-4000 mg daily, which is approximately 1% of an average human's diet (Ip et al. 1999a).

In an earlier study in Experimental Cell Research, CLA was shown to prevent mammary cancer in rats if given before the onset of puberty (Ip et al. 1999b). Even more important, if CLA was ingested during the time of the "promotion" phase of cancer development, the rats were conferred substantial protection from further developing breast cancer. Another significant finding was that CLA appeared to actually inhibit the growth of normal mammary epithelial cell organoids and induced apoptosis or cell death in some of those same cells. The researchers concluded that this led to a reduction in the density of the developing mammary glands in rats and, therefore, the incidence of breast cancer was reduced (Ip et al. 1999b).

In the June 1999 issue of the journal Carcinogenesis, CLA was shown to reduce the size of breast tissue in the rat and thereby reduce the incidence of carcinogenesis (Banni et al. 1999). In another study reported in Anticancer Research, it was shown that CLA is also able to inhibit the growth of prostate cancer (Cesano et al. 1998). As reported in the article, CLA can be considered to be a powerful prostate cancer preventive as well as a partial treatment.

CLA may work via a similar mechanism to anti-diabetic drugs such as Avandia and Actos to not only enhance insulin sensitivity, but to also protect against cancer. A report in the journal Medical Hypothesis pointed out that a number of human cancer cell lines express the PPAR-gamma transcription factor, and agonists for PPAR-gamma can promote apoptosis in these cell lines and impede their clonal expansion both in vitro and in vivo. CLA can activate PPAR-gamma in rat adipocytes, possibly explaining the anti-diabetic effects of CLA in Zucker fatty rats. The report concluded by stating: "It is thus reasonable to suspect that a portion of CLA's broad spectrum anti-carcinogenic activity is mediated by PPAR-gamma activation in susceptible tumors" (McCarty 2000). Note: The term "PPAR-gamma" is an acronym for "peroxisome proliferator activator-receptors-gamma." A PPAR-gamma agonist such as Avandia, Actos, or CLA activates the PPAR-gamma receptor. This class of drug is being investigated as a potential adjuvant therapy against certain types of cancer.

Another finding that provides insight into the biochemical action of CLA is its ability to suppress arachidonic acid. Since arachidonic acid can produce inflammatory compounds that can aid cancer proliferation, this may be yet another explanation for the anticancer effects of CLA. The suggested amount required to obtain the overall cancer-preventing effects is only 3000-4000 mg a day.

Clearly, we can expect more research and more interest in this fascinating supplement that has already been proven to be a formidable foe against cancer and to be able to promote weight loss with the development of lean tissue.

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Obesity

How CLA Induces Fat LossThe May 2002 issue of The Journal of Nutrition described a study conducted to ascertain the effects of CLA on calorie burning and fat storage in mice (Terpstra et al. 2002). CLA was shown to lower the amount of ingested food that was stored as body fat. CLA also increased the amount of fat excreted in the feces. Additionally, the study found that CLA induced a reduction in body fat mass on mice fed either a calorie-restricted or normal diet. The scientists defined the term "energy expenditure" as being the amount of food ingested minus the food retained in the body carcass and in the feces. CLA-fed mice showed a 74% increase in energy expenditure. The scientists thus concluded that the lower amount of ingested food stored on the body carcass was accounted for by this significant increase in energy expenditure (Terpstra et al. 2002).

This new finding corroborates a study conducted at Louisiana State University in which feeding male mice a CLA-enriched diet for 6 weeks resulted in 43%-88% lower body fat, especially in regard to abdominal fat. This occurred even if the mice were fed a high-fat diet. The effect was partly due to reduced calorie intake by CLA-supplemented mice and partly to a shift in their metabolism, including a higher metabolic rate (West et al. 1998).

In another study, performed at the University of Wisconsin-Madison, mice supplemented with only 0.5% of CLA showed up to 60% lower body fat and up to 14% increased lean body mass compared to controls. The researchers discovered that CLA-fed animals showed greater activity of enzymes involved in the delivery of fatty acids to the muscle cells and the utilization of fat for energy, while the enzymes facilitating fat deposition were inhibited (Terpstra et al. 2002).

The Safety of CLAIn a study conducted by the Nutrition Department of Kraft Foods, male rats were fed a diet of 1.5% CLA, which is 50 times higher than the estimated upper-range human intake. The animals were examined weekly for any signs of toxicity; no toxicity was found. After the end of the 36-week study, the animals were sacrificed and autopsied. Again, no abnormal pathology was found. The study confirmed that CLA supplementation is safe even at high doses. Nevertheless, high doses are not necessary for obtaining the benefits of CLA (Scimeca 1998).

A dose of three to four 1000-mg capsules of 76% CLA, taken in the morning or before lunch on an empty stomach, may be an effective part of an overall weight-loss program. Research studies indicate that it usually takes about 3 weeks before body fat loss occurs in response to CLA supplementation.

HOW GUARANA INDUCES FAT LOSS

Clinical Studies on Guarana

Guarana is an herb that contains a form of caffeine called guaranine which is 2.5 times stronger than the caffeine found in coffee, tea, and soft drinks. What makes guaranine unique from the caffeine found in beverages is its slower release. That is because the guarana seed is fatty (even in powder form) and is not readily water-soluble. Therefore, the body does not quickly absorb it.

Since guaranine is released slowly, over a period as long as 6 hours, the energy boost that is experienced from guarana is not like that of coffee (a sudden rush and quick drop-off). Rather, the energy boost continues to escalate over hours.

While caffeine from beverages provides a short-lived energy burst that overheats and excites the body, guaranine has a cooling action that revitalizes and relaxes. This is because guarana contains other components that modify the activity of guaranine. The end result is more beneficial to the body than tea or coffee.

Guarana aids in a temporary, natural increase in body temperature and metabolic thermogenesis through nutritional stimulation of the body's beta-receptor pathway, which can induce the breakdown and release of stored body fat and thereby allow stored fats to be turned into energy. Thermogenesis refers to the body's production of heat. Heat production is a normal part of metabolic processes and can be enhanced by certain nutritional substances. Thermogenesis is both a source of heat and, when stimulated through appropriate dietary supplementation, a mechanism to increase metabolic rate. Stored body fat, if released and available for use, can provide the fuel for this increased metabolic rate.

Other active constituents of guarana are theobromine and theophylline, which are called xanthines (a class of thermogenic substances found in coffee, tea, and certain beans). They have some effect on increasing metabolic rate, suppressing appetite, and enhancing both physical and mental performance. They also act as muscle relaxants and possess diuretic properties.

Interestingly, caffeine accelerates the effectiveness of CLA, thus making CLA a more potent fat burner. Guarana has been shown to stimulate the migration of lipids so fat can be burned as energy. It is also an appetite suppressant.

Guarana also increases mental alertness, fights fatigue, and increases stamina and physical endurance. Guarana is taken daily as a health tonic by millions of Brazilians. In the United States, guarana holds GRAS-status (Generally Regarded as Safe). In 1989 a patent was filed on a guarana seed extract that was capable of inhibiting platelet aggregation in mammals. The patent described guarana's ability to prevent the formation of blood clots and to help in the breakdown of clots that had already been formed. Clinical evidence was presented in conjunction with the patent in 1989 and again in 1991 by a Brazilian research group demonstrating these anti-aggregation properties (Bydlowski et al. 1991).

Clinical Studies on GuaranaIn a study reported in The Journal of Human Nutrition Diet, guarana extract induced weight loss for over 45 days in overweight patients taking a mixed herbal preparation containing yerbemate, guarana, and damiana (Andersen et al. 2001). Body weight reductions were 11.22 pounds in the guarana group compared to less than 1 pound in the group receiving placebo for 45 days.

Guarana extract and its fractions decreased platelet aggregation up to 37% of control values and decreased platelet thromboxane formation from arachidonic acid up to 78% of control values (Bydlowski et al. 1991). When platelets hyperaggregate and/or when excess thromboxane formation occurs, this can initiate an arterial blood clot, which results in a heart attack or ischemic stroke.

In a 1997 study in rats, guarana increased the physical activity of the rats as well as increased physical endurance under stress and increased memory with single doses as well as with chronic doses. Interestingly enough, this study revealed that whole guarana seed extract performed better and more effectively than a comparable dosage of caffeine or ginseng extract (Espinola et al. 1997).

Another Brazilian research group has studied the apparent effect of guarana to increase memory, which is thought to be linked to the essential oils found in the seed (Galduroz et al. 1996). Its antibacterial properties against Escherichia coli and Salmonella have been documented as well (da Fonseca et al. 1994).

A 1998 toxicology study with animals has shown that guarana is nontoxic at even high dosages of up to 2 grams/kg of body weight. This same study demonstrated the antioxidant properties of guarana, saying: "Guarana showed an antioxidant effect because, even at low concentrations (1.2 mcg/mL), it inhibited the process of lipid peroxidation" (Mattei et al. 1998).

A major advantage to taking guarana in an oil base capsule is its relatively slow release into the body. In a study reported in the journal Pharmacology Biochemical Behavior in November 1997, a comparison was made of the absorption of caffeine from coffee, cola, or capsules. Based on saliva caffeine concentrations, the absorption from capsules was about 40% slower than that of coffee or colas. These capsules were not oil-based, yet the rate of caffeine absorption was still significantly slower than coffee or cola (Liguori et al. 1997).

CLA + GUARANA

The effect of CLA on blocking excess absorption of serum glucose and fatty acids into adipocytes (fat cells) is remarkable. CLA induces a reduction in the size of adipocytes. One of the reasons that people gain weight as they age is that their adipocytes literally become fatter.

Another cause of increased body fat storage is the proliferation of adipocytes. Whereas CLA helps block the absorption of fat and sugar into adipocytes, CLA does not reduce the actual number of adipocytes present. Guarana has been shown to specifically reduce the number of adipocytes. When CLA was combined with guarana, there was a 50% reduction in adipocyte number (FASEB 2002).

In response to the FASEB (2002) study showing an added benefit when CLA is combined with guarana, a supplement has been formulated that contains potencies of CLA and guarana that have demonstrated fat-loss effects in published studies (available from Life Extension Foundation). CLA is also available by itself as a supplement for those who are overly sensitive to caffeine.

Whereas many published studies document the fat-reducing effects of CLA, the fact that CLA may protect against cancer, vascular disease, and Type II diabetes makes it a preferred supplement for health-conscious people to use daily.

THE "FRIENDLY" FATS

Essential Fatty Acids

There are fats that are healthy and fats that are dangerous. Hydrogenated fats are made by bubbling hydrogen gas with nickel as a catalyst to make the oil more solid at room temperature. This is how margarine and Crisco are made. During the process, many of the chemical bonds are broken and reformed into less healthy trans configurations.

Healthy fats have a distinct flavor and unfortunately tend to become rancid after a few weeks, even with refrigeration. The healthiest oils are cold-pressed to avoid the chemical changes that occur during heating. Healthy oils are made from olives, flax seed, borage seeds, and even hemp. Each has its own unique flavor.

Not long ago, low-fat diet gurus were trying to terrorize people into further reducing all fat consumption. Now that we have witnessed the epidemic of obesity that followed, we know better. Healthy fats help keep us slender! They also help protect against atherosclerosis, cancer, diabetes, autoimmune diseases, and various other degenerative disorders.

Through their impact on important metabolic enzymes, healthy fats increase the synthesis of beneficial prostaglandins E1 and E3 while decreasing the levels of inflammatory prostaglandin E2; they also modify cell membrane composition and fluidity. Hence, improved blood flow and tissue oxygenation, higher metabolic rate, improved insulin sensitivity, immune enhancement, more muscle and bone formation, better brain function, and faster nerve impulse conductance result, to mention just a few of the major benefits.

Thus, while in the 1970s and 1980s dietary fat was demonized and presented as being a problem, we are beginning to see various kinds of healthy fat as part of the solution.

Essential Fatty AcidsThe omega-3 and omega-6 oils are called essential fatty acids because the body needs them to remain healthy. (Technically, only linoleic acid is an “essential†fatty acid in the strict biochemical sense, because it can not be synthesized by the body and must be ingested with food to support life.) The brain is composed almost entirely of essential fatty acids. Clinically, essential fatty acids (such as flax and borage oils) have a marked anti-inflammatory effect on the body.

Many times, scientific studies run counter to popular beliefs that are often spread via media commercials designed to sell a particular product. One such belief says that we should avoid all fats in order to lose weight. While this is true in the case of simple fats, the essential fatty acids found in high-quality oils are very healthy and may also promote weight loss.

An article in The American Journal of Clinical Nutrition described a study of dietary fish (Mori et. al. 1999). Overweight patients being treated for hypertension were randomly assigned to a daily fish meal (3.65 g of omega-3 fatty acids); a weight-loss regimen; the two regimens combined; or a control group for 16 weeks. Fasting triglycerides fell 29% with fish consumption and 26% with weight loss. The fish plus weight-loss regimen group showed the greatest improvement in lipids: triglycerides decreased by 38% and HDL(2) cholesterol increased by 24% compared with the control group. The authors concluded that adding a daily fish meal into a weight-loss regimen was more effective than either measure alone at improving glucose-insulin metabolism and dyslipidemia (Mori et. al. 1999).

The essential (omega-3) fatty acids found in fish oils are known to promote thermogenesis, the process by which foods are converted immediately to heat. In this way, the body burns off the calories instead of converting them into fats for storage (McCarty 1994). Another benefit of essential fatty acids is to make cell membranes more sensitive to the effects of insulin (Storlien et al. 1986, 1987, 1996; Borkman et al. 1993; Vessby et al. 1994; Pan et al. 1995). As discussed earlier in this protocol, insulin-resistance is a prime factor causing people to gain unwanted fat pounds as they age.

Eating fish is a good way to promote weight loss. Many people also choose to take essential fatty acid supplements that are high in DHA (docosahexaenoic acid) from fish oil extracts and GLA (gamma-linolenic acid) from borage oil. Other options include flax or perilla oil supplements that contain alpha-linolenic acid (precursors to DHA and EPA). Consumption of these essential fatty acids confers a significant protective effect against chronic inflammation and vascular disease, a common problem in overweight people.

CHROMIUM

While thyroid hormone plays a definite role in weight management, both magnesium and chromium are also required to break down the cellular insulin resistance that causes higher blood sugar levels.

Overweight people usually experience insulin impairment that prevents the proper carbohydrates (sugars) from being metabolized by their muscle cells. Excessive serum glucose is converted into body fat unless this insulin resistance is broken down and the cells are able to regain youthful carbohydrate metabolism. Chromium has received widespread publicity for its ability to lower serum glucose levels by potentiating insulin sensitivity. Studies have shown that chromium supplementation results in a slight reduction in body fat and an increase in lean body mass. Niacin has been shown to improve the metabolic-enhancing effect of chromium. Chromium polynicotinate may be involved modulating the sensitivity of the insulin receptor, making the cell more sensitive to circulating insulin.

In 1997, Austrian researchers conducted a study to assess the effects of chromium yeast and chromium picolinate on lean body mass during and after weight reduction with a very low-calorie diet: 36 obese nondiabetic patients undergoing an 8-week, very low-calorie diet followed by an 18-week maintenance period were evaluated. During the 26-week treatment period, study subjects received either placebo or chromium yeast (200 mcg/day) or chromium picolinate (200 mcg/day) in a double-blind manner. After 26 weeks, chromium picolinate-supplemented subjects showed increased lean body mass. Researchers reported chromium picolinate, but not chromium yeast, is able to increase lean body mass in obese patients in the maintenance period after a very low calorie diet without counteracting the weight loss achieved (Bahadori et al. 1997).

To improve the fat-reducing effects of dieting, a 200-mcg chromium capsule should be taken with every meal to facilitate youthful carbohydrate metabolism. The importance of taking a chromium capsule with each meal is illustrated in animal studies in which chromium was given throughout the day in order to lower serum glucose levels. When an individual consumes food, serum glucose levels rise significantly unless the cells are sensitized to insulin. Chromium will help sensitize your cells to insulin by helping to lower your blood sugar levels.

Do not take more than three 200-mcg chromium capsules a day. Always take antioxidant supplements such as vitamin E when taking chromium to protect against free-radical activity. At least 30 mg of niacin should be contained in each 200-mcg chromium capsule to facilitate its effects in the body.

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Obesity

MAGNESIUM

While chromium has received considerable media attention, the scientific literature shows that magnesium plays an even more important role in regulating carbohydrate metabolism. Magnesium is involved in a number of the enzymatic reactions required for cells to uptake and metabolize glucose. Magnesium deficiency causes insulin resistance and elevated blood sugar levels (Paolisso et al. 1990; Nadler et al. 1993, 1995; Lefebvre et al. 1994).

Approximately 80% of Americans are magnesium-deficient. When magnesium-deficient individuals go on a diet, they often become severely magnesium-deficient, which aggravates insulin resistance and contributes to the failure of the diet. For those individuals going on a calorie-restricted diet, it is suggested that 300-500 mg of supplemental magnesium be taken each day.

STEVIA

Stevia is a South American herb (Stevia rebaudiana) that is known locally as "sweet herb" or "honey leaf." Stevioside extracted from this plant is 100-300 times sweeter than table sugar, yet it is not a carbohydrate. Stevia extract and powder can be used as a sweetener both in beverages and in cooking.

IMPLEMENTING A NATURAL WEIGHT LOSS PROGRAM

Step 1 Step 2 Step 3 Precautions for Natural Weight Loss Protocol

Taken together, everything presented so far provides a comprehensive approach to inducing fat-loss and achieving sustained weight control. Many of the weight-loss supplements outlined in Step 1 of the following summary can be safely initiated without the need for hormone blood tests.

However, to optimize long-term weight management, we encourage the hormone blood profile as recommended in Step 2 of the following summary. Too often, only partial weight loss results are achieved because imbalance of hormones such as testosterone, estrogen, and thyroid (T3) prevent the body from releasing more stored body fat.

Following is a summary of what should be done to implement a scientific-based weight loss program:

Step 1: Take the following dietary supplements to facilitate immediate weight loss:

Supplement

Dose

PGXâ„¢ highly viscous fiber blend

1,000-3,000 mg daily before each meal (with 8-16 ounces of water)

CLA (76%) 1000 mg or CLA with Guarana extract

3-4 capsules early in the day 3-4 capsules early in the day

CitriChrome(chromium polynicotinate)

600-1,000 mcg daily, or 2-3 200-mcg capsules with each meal

Super GLA/DHA (essential fatty acids) or Super EPA/DHA with Sesame Lignans

4 capsules per day

Life Extension Mix (provides high doses of magnesium, zinc, and other important nutrients)

3 tablets, three times per day

Fiber (psyllium seed, guar, and pectin)

Start with 4 grams taken when high-fat meals are consumed. Do not take with CLA or Super EPA/DHA because fiber will bind to these important fatty acids before they can be absorbed into the bloodstream.

Step 2: Obtain the following blood tests from your physician or order them directly by calling .

Complete blood chemistry (includes serum glucose) Fasting insulin Free testosterone Estradiol Thyroid panel (T3, T4, TSH) DHEA PSA (for men) Fasting insulin

(Be certain to not eat anything for 12 hours prior to having blood drawn.)

Step 3: Once the test results are received, initiate hormone modulation therapy as follows:

If there is any indication of thyroid deficiency, take an appropriate thyroid replacement medication (usually Cytomel). The starting dose of Cytomel is normally 12.5 mcg twice per day.

If DHEA levels are low (they almost always are in people over age 35), then take the appropriate amount of DHEA (15-50 mg/day) to restore them to a youthful range. (Refer to DHEA Replacement Therapy protocol for precautions.)

For men, if free testosterone is in the low normal range or below normal, ask your physician to prescribe a transdermal cream to provide 5 mg per day of natural testosterone. If estradiol levels are high (over 30), use 0.5 mg of the drug Arimidex twice a week to block the aromatase enzyme that converts testosterone to estrogen. Before using testosterone, men should verify that they do not have prostate cancer by having a blood test for PSA and undergoing a digital rectal exam.

Once armed with a youthful hormone profile, along with supplements that help facilitate weight loss, you are in a position to determine how much body fat you want to lose.

Once on this program, you will find it easy to make healthy food choices such as including more fresh fruits and vegetables in your diet, avoiding high sugar snacks, and reducing total calorie intake.

Based on our research, this three-step program is the only practical approach for the normal aging human to be rid of excess body fat over a continuous period. If you are seriously concerned about protecting yourself against multiple degenerative diseases and improving your appearance, we urge you to make the effort to have your blood tested, modulate your hormone profile accordingly, and take the supplements that can help you regain your youthful appearance. If you need a referral to a physician knowledgeable about hormone modulation, please call .\

Precautions for Natural Weight Loss ProtocolEven when taking natural weight loss supplements, there are still some precautions that should be followed to guard against adverse side effects. For instance, if an individual has uncontrolled hypertension, CLA with guarana should not be taken. Instead, use the CLA product without guarana. Even though guarana tends to release slowly in the body, individuals who are hypersensitive to caffeine may want to use the CLA alone product.

Reduced thyroid hormone output is a common response when less food is consumed. This response is nature's way of conserving body mass in response to what it perceives as a famine. If you significantly reduce food consumption, check thyroid hormone status and ask your physician for Cytomel or Armour drug therapy if body temperature or blood tests indicate thyroid deficiency. Refer to the Thyroid Deficiency protocol for details.

Chromium can induce the production of free radicals. Therefore, when taking a chromium supplement, be certain to simultaneously consume an antioxidant supplement.

Obesity and weight loss remain controversial subjects. Scientists have identified underlying causes for age-associated weight gain. Yet the majority of overweight people and their physicians ignore these findings. The result is that most diet and exercise regimens fail.

The fact that conventional weight-loss methods do not work is confirmed by more Americans being obese and overweight than ever before. Yet never have so many people tried to reduce body fat.

SUMMARY

Type I (insulin-dependent) diabetes was at one time universally fatal. In 1922, a young boy received the first form of supplemental insulin and experienced a reduction of blood sugar. Insulin was soon viewed as a wonder drug because it saved the lives of those who were previously doomed to death shortly after diagnosis with insulin-dependent diabetes.

In today’s gluttonous world, overproduction of insulin has become a major health problem. Even in people who eat a healthy diet, the aging process often causes insulin resistance that results in higher-than-desired insulin levels. An overwhelming number of scientific studies show that hyperinsulinemia is an underlying culprit for many of today’s killer diseases and infirmities.

While pharmaceutical companies are investigating insulin-suppressing drugs, the good news is that fiber supplements have been shown to enhance blood sugar control, decrease after-meal insulin levels, and reduce the number of calories absorbed by the body.

The best fiber sources for reducing after-meal blood sugar-insulin levels, lowering cholesterol levels, and promoting weight loss are those that are rich in water-soluble fibers such as glucomannan, psyllium, guar gum, pectin, and especially, PGXâ„¢ highly viscous fiber blend.

When taken with water before meals, these fiber sources bind to the water in the stomach and small intestine to form a gelatinous, viscous mass that not only slows down the absorption of glucose, but also induces a sense of satiety (fullness) and reduces the absorption of calories.

With the introduction of a new highly viscous fiber blend trademarked under the name PGXâ„¢, it may now be possible to achieve the multiple documented benefits of fiber by swallowing only a few capsules before each meal. The longevity potential associated with reducing after-meal glucose and insulin blood levels, lowering total cholesterol and LDL, and losing some weight is enormous

While the long-term objective of any diet modification program is to maintain healthy body mass index (BMI below 25) with a reduced calorie intake, it is more important initially for obese individuals to shift the time of day when they consume the most calories. The instructions to overweight and obese individuals given earlier in the protocol will be repeated in order to achieve rapid and sustained fat loss:

Immediately after wakening: Eat a large breakfast. If you want a banana split, eat it for breakfast! Eat as much as you want of whatever you want. The reason we advocate a liberal breakfast is that you should follow this program for the rest of your life. If you are continuously deprived of the foods you like, at some point you may rebel and start eating at the wrong time of the day. Ideally, breakfast will consist of fresh fruit and whole grains, but if you need to consume high calorie foods, do it in the morning and not late in the day. Late morning: Eat a snack equivalent in calories to a hamburger and potato fries. Healthier foods are recommended, but for the purposes of complying with this program, eat what you want at this time of the day instead of waiting until the evening when these calories readily convert to body fat. Mid-afternoon: Have another snack equivalent to the calories obtained from a tuna salad sandwich on whole wheat bread and some fruit. Dinner: No later than 6:30 p.m. have a modest dinner: fish or lean chicken-meat, potato, and several vegetable servings. After dinner: Nothing goes in your mouth but pills and the water to swallow them! 5-10 minutes before each meal above, consume 1000-3000 mg of PGXâ„¢ highly viscous fiber blend with 8-16 ounces of water.

It may take a week for some obese individuals to wake up hungry (as they are supposed to do) and not have the desire to eat after 6:30 p.m. After 45 days of following this program that alters the time of day when calories are consumed, an improvement in several metabolic parameters should become evident, including a reduction in fasting insulin levels. Enough fat loss should have occurred during this initial 45-day period to motivate the individual to reduce total calorie intake and begin to exercise. Using PGXâ„¢ highly viscous fiber blend with 8-16 ounces of water makes restricting calorie intake much easier by cutting carbohydrate craving.

There are three important reasons to cut calorie intake throughout life:

The risk of degenerative disease declines dramatically in those who remain thin. Reducing calorie intake slows and possibly reverses aging. One of the most important aspects of one's appearance and self-esteem is to avoid the accumulation of unsightly body fat.

The appendices following this protocol provide information about conventional weight loss drugs, gastric surgery, the glycemic index, assessing insulin status, and other methods that have been promoted to be of help in shedding excess body fat.

For most people, the best weight-loss results will occur if they follow the three simple steps outlined in the preceding section, which were:

Supplement with PGX™ highly viscous fiber blend with 8-16 ounces of water, CLA, chromium, magnesium, fish oil. Check hormone blood levels. Take corrective action if there are any hormone imbalances such as asking your physician for a prescription for Cytomel if T3 levels are low; testosterone cream if testosterone levels are low; an aromatase inhibitor (such as Arimidex®) if estrogen levels are high (primarily for men), etc.

Combining the three steps listed above with a shift in calorie consumption to early in the day can produce profound body fat loss and sustained weight control.

PRODUCT AVAILABILITY

PGXâ„¢ highly viscous fiber blend, CLA with Guarana or CLA-only capsules, Cytochrome, Life Extension Mix, Super EPA/DHA with Sesame Lignans and other essential fatty acids, DHEA, magnesium, stevia, and fiber capsules and powders can be ordered by calling or by ordering online. Blood tests to ascertain hormone status, PSA, and other important parameters can be ordered by calling . Cytomel, Arimidex, and testosterone creams are prescription drugs. If you need referral to a physician knowledgeable about the hormone medications discussed in this protocol, call (800)226-2370 or log on to www.ledocs.com.

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Obesity

APPENDIX A

Weight Loss DrugsAmphetamine and related sympathomimetic medications are thought to stimulate the release of norepinephrine and/or dopamine from storage sites in nerve terminals in the lateral hypothalamic feeding center, thereby producing a decrease in appetite.

Adrenergic drugs for weight loss include phentermine (Adipex, Fastin, Ionamin); diethylpropion (Tenuate, Tepanil); phendimetrazine (Adipost, Bontril, Plegine, Prelu-2); and benzphetamine (Didrex). These drugs are chemically related to amphetamine. Mazindol (Sanorex, Mazinor) is an isoindole thought to inhibit the reuptake of norepinephrine rather than to cause its release.

Adrenergic weight loss drugs are all classified as controlled substances by the U.S. Drug Enforcement Agency (DEA) due to their tendency to cause dependency and the risk of abuse. All of these drugs are approved by the U.S. Food and Drug Administration (FDA) for short-term use (about 12 weeks) (FDA 1992).

Sympathomimetic appetite suppressants stimulate the central nervous system and elevate blood pressure. Side effects of these drugs include dry mouth, anxiety, insomnia, dizziness and lightheadedness, headache, palpitations, and (rarely) increased blood pressure. Tolerance to the effects of medications in this class usually develops within a few weeks and rebound weight gain may occur after discontinued use of the medication. One important action of all sympathomimetic agents is that, like adrenaline, they stimulate release of fatty acids from adipose tissue and promote the burning of fatty acids.

Give a physician your complete medical history especially if you have high blood pressure, an overactive thyroid, glaucoma, diabetes, or emotional problems. Inform your physician if you think you are pregnant or if you are breast-feeding. Limit alcohol use. Alcohol can increase unwanted side effects of dizziness. Adipex and other stimulants that work via this mechanism are not recommended for use in children.

Also inform your physician about all medicines used (prescription and nonprescription), especially if you take high blood pressure medicine or MAO inhibitors (e.g., furazolidone, phenelzine, selegiline, tranylcypromine) or any other weight-loss medicine. Decongestants are commonly found in over-the-counter cough and cold medicines.

Orlistat (Xenical) is unique among current obesity drugs in that it does not act directly on the central nervous system. Orlistat inhibits an enzyme (pancreatic lipase) essential to fat digestion. In 2 years of clinical trials, orlistat has produced sustained weight loss similar to that of other single agents.

The most common side effects are intestinal symptoms, including cramping, gas, and diarrhea, particularly in patients who eat high-fat foods against the advice of their physician. It is possible that the desire to avoid these unpleasant side effects might encourage people to eat a diet that is lower in fat, thereby helping them to lose weight.

Sibutramine (Meridia) increases the levels of both serotonin and noradrenaline in areas of the brain that regulate food intake and body weight. It produces 1-year weight loss similar to that of other single agents and reduces some complications of obesity such as those involving blood glucose and lipids. Unlike some other anti-obesity drugs, sibutramine does not reduce blood pressure. The side effects may include dry mouth, lethargy, drowsiness, and insomnia

Obesity is associated with decreased human growth hormone levels. Insulin is a very potent inhibitor of growth hormone release. This explains why eating carbohydrate-containing meals 3-4 hours prior to going to sleep prevent the growth hormone surge that typically occurs about 90 minutes into sleep. In individuals that are over 30 years of age, this sleep-related release of growth hormone is the only significant way they have left to release growth hormone. The only other way is via intense physical activity, something that declines with aging. Growth hormone is released by the pituitary gland in response to exercise, deep sleep, hypoglycemia, and ingestion of protein. It stimulates the production of RNA (ribonucleic acid), mobilizes fat deposits, and is a central part of insulin metabolism (Fischbach 1996). Decreased levels of growth hormone are associated with obesity and corticosteroid use. Therapies that boost growth hormone can help facilitate weight loss. The cost of human growth hormone injections is cost-prohibitive for most people.

Most weight loss drugs have side effects that cause many people to discontinue using them before significant results are obtained.

APPENDIX B

Exercise and DietThe goal of any weight-loss program is to attain better health through improved diet and exercise, in addition to restoring one's metabolic profile to fit that of a 21-year-old.

It is difficult for many overweight individuals to engage in exercise because excess body fat makes them too lethargic to contemplate a consistent exercise program. Additionally, some people just will not exercise. By properly modulating hormone levels, some individuals will feel revitalized enough to become physically active.

Restoring hormones to reflect more youthful profiles will produce some quick fat loss and alleviate depression. Feeling better and seeing real weight reduction can induce many people to improve their diet.

Those who remain hopelessly overweight may not be able to focus on proper diet or exercise, because neither was effective for them in the past. That is why it is so crucial to restore one's metabolic profile to a healthy, youthful level. For most people, this requires proper hormone balance. When there are hormone imbalances, such as too much fasting insulin and/or not enough testosterone, DHEA, or thyroid, people gain weight. These age-related hormone imbalances often preclude sustained weight control, despite agonizing diet and exercise programs that are supposed to work!

APPENDIX C

The Glycemic Index What Is the Glycemic Index Food Fraud

The Glycemic IndexMuch attention is being paid to avoiding foods that have a high glycemic index and glycemic load. The hypothesis is that since high glycemic foods increase production of insulin, avoiding them and eating only low glycemic foods will facilitate fat loss by reducing excess insulin. The problem with obese and severely overweight individuals relying on low glycemic diets is that they are already making too much insulin to achieve meaningful fat loss.

A review of published studies comparing the effects of consuming high as opposed to low glycemic diets on weight loss has yielded mixed results. Many studies indicate that it is healthier to eat lower glycemic index as opposed to high glycemic index foods, especially for diabetics.

A study in the July 2002 issue of the American Journal of Clinical Nutrition clarified many of the existing published studies by showing increased weight loss and other health benefits associated with consuming low glycemic index foods (Pi-Sunyer 2002).

Controversy still remains regarding the merits of low carbohydrate diets in the control of obesity. When one considers the well-established roles played by insulin and thyroid hormones in the storage and burning of fatty acids, respectively, it is prudent for any biochemist or endocrinologist to favor the merits of a low carbohydrate diet. As described in greater detail in the section above on thyroid hormones, glucose is the preferred energy source of all tissues, while fat is the preferred way to store energy. Until one’s diet can result in a sustained decrease in glucose, no significant amount of body fat will be burned. The interplay of hormones of fat and glycogen storage (insulin), hormones of glucose production from fat and protein (adrenaline and cortisol), and hormones that oppose conservation of energy primarily as fat (thyroid hormone) all suggest that dietary intake of carbohydrates must be manipulated in such a way as to lower blood glucose levels and to ultimately promote mobilization of fat for energy production, thus sparing available and now limited stores and sources of glucose. There is no agreement on how to accomplish this though the logical thinking scientist has to favor a reduction in overall carbohydrate intake simply because all carbohydrate must first be metabolized into glucose. Glucose and insulin are the most closely aligned factors in a negative feedback loop that is central to energy use and storage for the entire body.

This appendix provides the reader with the basis for why consuming low glycemic foods is currently the best solution for obesity. For severely overweight individuals, it is at best only a partial solution. This Obesity protocol has meticulously validated the need to correct multiple metabolic disorders in order to achieve significant and sustained fat loss. The failure to correct for even one metabolic imbalance (such as low T3) can compromise any fat loss program.

What Is the Glycemic Index?Glycemic index refers to the rate blood glucose levels rise after eating food, in comparison with an equivalent amount of pure glucose (sugar) or white bread. Many people are sensitive to carbohydrates even though they have normal fasting glucose levels.

Foods with high glycemic indices include corn flakes, instant potatoes, honey, pasta, bread, rice, and potatoes. Food with a low glycemic index include kidney beans, lentils, soy beans, peanuts, butter and haricot beans, blackeye and chick peas, apples, ice cream, milk, yogurt, and tomato soup.

Interestingly, ice cream has a fairly low glycemic index, a result of the fats that tend to slow blood sugar rises. This emphasizes the complexity of the subject of diet. Although ice cream is considered a low-glycemic index food, it is high in calories, carbohydrates, and fats.

Persons who have carbohydrate cravings and food addictions should be particularly aware of the glycemic index. Certain carbohydrates can cause a sudden elevation of glucose in the blood with a sudden rush of energy often accompanied by feelings of dizziness or lightheadedness followed by a "crash." In particular, children may become addicted to the energy rush from snacks and soda. The pattern is often continued into adulthood by substituting coffee and donuts (for breakfast) or by eating cakes and cookies (after dinner).

Get into the habit of stocking your refrigerator with oranges, grapefruit, apples, pears, and berries. These fruits have been shown to reduce disease risk as opposed to refined sugar snacks that cause excessive fat accumulation.

While people seeking to lose body fat try to avoid sucrose and fructose, too often the intense craving for sugar (induced by hyperinsulinemia) results in carbohydrate bingeing.

The food industry misleads the public into thinking that high-glycemic foods are healthy. For instance, orange juice is promoted as a source of folic acid, vitamin C, and calcium. The downside to orange juice is that it induces an acute influx of fructose into the bloodstream that then spikes serum insulin. When an orange is eaten, there is only a gradual release of sugar into the blood. However, once fruits or vegetables are juiced, they become catalysts for insulin overload because of their high concentration of rapidly absorbable sugar.

Carrots have a high-glycemic index, but since their glycemic load is very low, there is nothing wrong with eating carrots. However, once carrots are juiced, the sugar is concentrated into a form that instantly hits the bloodstream and provokes an insulin spike. The moral to this story is to eat high amounts of fruits and vegetables, but avoid their juice. A look at the calorie content of a glass of fruit or vegetable juice confirms their fat-inducing effects. For those persons who are concerned about obtaining adequate folic acid, vitamin C, alpha-carotene, etc., these nutrients can be obtained by eating whole fruits and vegetables and by taking supplements.

As can be seen in this section, foods that were once considered part of a healthy "low-fat diet" have a very high glycemic index and glycemic load. This means that ingesting too many of these types of foods could cause weight gain, even if you think you are eating a healthy diet.

As shown in Table 1, eating too many high sugar-content foods and beverages causes the release of excess insulin. When evaluating the insulin-elevating effects of foods, two measurements to consider are the "glycemic index" and "glycemic load." The "glycemic index" measures how fast a carbohydrate triggers a rise in circulating blood sugar. The "glycemic load" assesses the impact of carbohydrate consumption, but provides a fuller picture than does the glycemic index alone. Foods that are high in both of these measurements should be reduced.

Comparison of High and Low Glycemic Index Foods

High Glycemic Index + High Glycemic Load

Lower Glycemic Index + Low Glycemic Load

Glycemic Index*

Glycemic Load*

Glycemic Index*

Glycemic Load*

Instant Rice**

91

24

Popcorn

72

8

Baked Potato**

85

20

Watermelon

72

4

Corn Flakes

84

21

Carrot

71

4

Corn Chex

83

21

Ice Cream

62

8

Pretzels

83

16

Oat Bran, raw

50

2

Corn Pops

80

21

Green Peas

48

3

Doughnut

76

17

Grapes

43

7

French Fries

75

22

Orange

42

5

Bread Stuffing

74

16

Apple

40

6

Cheerios

74

15

Strawberries

40

1

Kaiser Rolls

73

12

Fish Fingers

38

7

Bagel

72

25

Apple

36

8

White Bread

70

21

Pear

33

4

Pancakes

67

39

Yogurt, low fat

31

9

Cranberry Juice Cocktail

68

24

Lentil Beans

29

5

Fanta® Orange Soft Drink

68

23

Peach

28

4

Mars Bar

65

26

Milk

27

3

Rye Bread

65

20

Plum

24

3

Sweet Corn

60

20

Kidney Beans

23

6

Macaroni and Cheese

64

32

Cherries

22

3

Sushi

52

19

Cashew Nuts, salted

22

3

Orange Juice

52

12

Peanuts

14

1

Linguini

48

23

Broccoli

--

--

Based on Table 1, when eating out, try to avoid eating bread. Ask for a double portion of vegetables in lieu of potato or rice. Cut back on desserts, especially at night. If you have an insatiable sweet tooth (carbohydrate craving), eat dessert in the morning, not at night. Consume higher glycemic carbohydrates in the morning, trying to reduce your intake after 12 noon. While these dietary changes can be difficult to implement, the effects of slowly reducing serum insulin can make this diet modification tolerable in the long run.

*Note that there can be variations of the actual glycemic index/load based on the brand or particular lot of the food/beverage. Glycemic load calculation is based on differing quantities of each food group.

**Some weight-loss physicians allow potatoes and rice as long as an overall reduced glycemic program is followed.

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Obesity

Food FraudIn spite of the term "low-fat" or "fat-free" appearing on more and more food labels, a record number of Americans are overweight. The problem is that "low fat" often means "high sugar." For example, look at the label of fat-free salad dressings; they are loaded with sucrose or fructose.

Sugar is cheap and is a palatable alternative to oils that add fat calories. For instance, when looking at pasta sauce labels, you will see that the majority of them are loaded with "high fructose corn syrup" or just plain old sucrose. Eating these sugar-fortified sauces with high glycemic pastas and bread can create an enormous insulin spike.

Fruit and vegetable juices feature healthy-looking photographs on their labels, but when looking at the calorie content of these sugar concentrates, you should seek to consume the actual fruit or vegetable in lieu of the juice. Even products that purport to have health benefits such as tea beverages are often loaded with sugar.

Food companies have duped Americans into believing that anything that is low in fat is beneficial. Consumers should carefully read food labels to make sure they are not inadvertently loading up on insulin-spiking sugar calories.

When addressing the problem of high-glycemic diets, there are two obstacles to overcome. First is to cut the craving for sugar; the other is to change eating patterns to reduce intake of high-glycemic foods late in the day. The solution is to regulate insulin secretion in such a way that both late-day carbohydrate craving and excessive calorie intake is reduced.

The rush to eliminate dietary fat was originally based upon the notion that this would force the body to use its own fat supply to replace the loss of dietary fat and the fact that it is very easy for the body to take dietary fat and immediately store it as fat, especially when consumed late in the day. What was overlooked was the fact that excess sugars and carbohydrates are not needed to maintain normal blood levels of glucose and there is no significant mechanism to store this excess of sugar and carbohydrate as glycogen. Consequently, the excess of glucose (and fructose) is converted into saturated fat and stored as fat. This is even worse than eating fat because of the insulin response to all of this glucose which now severely inhibits metabolism of fat while it continues to promote the storage of even the slightest amount of consumed fat.

APPENDIX D

Gastric Surgery Risks of Surgery

Gastric SurgeryOne of the latest developments in treatment of obesity is the use of surgery to restrict food intake or to interrupt normal digestive function. These techniques are usually reserved for the severely obese, with a body mass index over 40, which corresponds to about 100 pounds overweight.

There are two surgical methods for weight loss: gastric banding and gastric bypass. In gastric banding, the amount of food the stomach can hold is reduced by closing off or removing parts of the stomach. A gastric bypass procedure reduces the digestion and absorption of food by connecting the stomach to the lower part of the small intestine, bypassing the duodenum and some of the jejunum.

Restrictive operations lead to weight loss in almost all patients, although some are unable to adjust their eating habits and fail to lose weight. About 30% of persons undergoing vertical banded gastroplasty achieve normal weight and about 80% achieve some degree of weight loss.

Gastric bypass operations are usually combined with restrictive operations to increase the effectiveness. Patients who have bypass operations generally lose two thirds of their excess weight within 2 years.

Risks of SurgeryIn 10%-20% percent of patients who have weight-loss surgeries, follow-up surgeries are required to correct complications. Abdominal hernia is the most common complication requiring follow-up surgery. Less common complications include breakdown of the staple line and stretched stomach outlets.

More than one third of obese patients who have gastric surgery develop gallstones. Gallstones are clumps of cholesterol and other matter that form in the gallbladder. During rapid or substantial weight loss, a person's risk of developing gallstones is increased. Gallstones can be prevented with supplemental bile salts taken for the first 6 months after surgery.

Nearly 30% of patients who have weight-loss surgery develop nutritional deficiencies. Decreased absorption of vitamin B12 can cause anemia, and decreased calcium absorption can cause osteoporosis and metabolic bone disease. These deficiencies can be avoided if vitamin and mineral intakes are maintained.

Gastric bypass operations may also cause "dumping syndrome," in which the stomach contents move too rapidly through the small intestine. Symptoms include nausea, weakness, sweating, faintness, and occasionally diarrhea after eating, as well as the inability to eat sweets without becoming so weak and sweaty that the patient must lie down until the symptoms pass.

APPENDIX E

Different Causes of ObesityObesity is most often attributed to increased intake of calories combined with a decreased output of energy. There are other clinical entities that might be the underlying cause or contributory factors of weight gain ( 1981; Healey et al. 1994; Bouchier et al. 1997):

Hypothyroidism (low thyroid hormone) Adrenal disease, including adrenal insufficiency, 's disease (adrenal deficiency), and Cushing's syndrome (adrenal excess) Pancreatic problems, including diabetes, insulin insensitivity (Syndrome X), and insulinoma (insulin stimulates appetite) Pituitary deficiency, including hypopituitarism (Frolich's syndrome), hyperprolactinemia, and 's syndrome Ovarian problems, including polycystic ovary syndrome (excess androgens, especially testosterone) and postmenopause Inflammation caused by chronic infections, including meningitis, encephalitis, tuberculosis, or syphilis Genetic disorders, such as Klinefelter's syndrome, Prader-Willi syndrome, ce-Moon-Biedl syndrome, Alstrom syndrome, Morel syndrome, Morgagni syndrome, Morgagni--Morel syndrome, Cohen's syndrome, or Carpenter's syndrome Excess fluid retention from cardiac, liver, or renal failure, nephritic syndrome, periodic edema, or hyperproteinemia states The use of drugs such as glucocorticoids, tricyclic and heterocyclic antidepressants, monoamine oxidase inhibitor antidepressants, lithium, phenothiazides, sulphonylurea agents, estrogens, and cyproheptadine (Bernstein 1987) Cessation of cigarette smoking and alcohol excess (pseudo-Cushing's) are highly associated with weight gain (Yarnell et al. 2000)

A common cause of obesity in women is Polycystic Ovary syndrome (PCOS). Until recently, PCOS was very hard to diagnose and even harder to treat. With modern ultrasound diagnostic technology and the advent of aromatase-inhibiting drugs and metformin (Glucophage), some physicians have achieved a high degree of success in treating this condition.

Overweight subjects also are uniformly deficient in growth hormone and its cleavage fractions including IGF-1. We believe this to be the result of deficient production of growth hormone releasing factor by the hypothalamus, all of which is related to obesity.

The most common cause of obesity is still probably the aging process itself. It is this process that causes the many hormones described in this Protocol to drop at the same time activity is falling off and consumption of calories continues or even increases. Unless there is a specific underlying disease entity that is more serious than these age-related changes in hormones, activity, and eating patterns, the most sensible approach for the normal aging individual is still smaller portions and no food after 6-7 pm.

APPENDIX F

Basic Dietary Information

Calories Basal Metabolic Rate Calculating the Insulin/Glucose Ratio

CaloriesA calorie is the amount of heat energy required to raise the temperature of 1 milliliter of water at a standard initial temperature 1 degree centigrade. Large amounts of energy are released during the digesting of food. A capital letter (K) is often used with "calorie" to denote kilocalories (1000 calories). For practical application, the following are the energy content of each of the categories of food:

Carbohydrates contain 4 kilocalories (Kcal) per gram. Protein contains 4 kilocalories per gram. Fat contains 9 kilocalories per gram. Alcohol contains 7 kilocalories per gram.

Basal Metabolic RateWhen a body is totally at rest, the amount of energy spent carrying out activities necessary to sustain life (such as respiration, circulation, etc.) is called the basal metabolic rate (BMR). When calculated over 24 hours, the average BMR is

1680 kcal for the average 70-kg (154-pound) man 1173 kcal for the average 58-kg (127.6-pound) woman

The process of digestion greatly impacts the basal metabolic rate because it requires energy. This energy expenditure is called diet-induced thermogenesis. Fats and carbohydrates increase the BMR by about 5%. An all-protein diet increases the metabolic rate by 25% because a large amount of energy has to be expended to burn to carbon atoms inside protein and to eliminate the nitrogen that is released. A mixed or balanced diet increases the BMR by 10%. However, severely restricting calories reduces the basal metabolic rate (by lowering thyroid hormone); thereby causing fatigue (from a decreased level of overall energy expenditure) and eventual weight gain (because food intake is generally not reduced). That is why thyroid hormone replacement is so important in many people who are going to restrict their calorie intake in order to lose weight. Adequate thyroid hormone status maintains the basal metabolic rate.

Calculating the Insulin/Glucose RatioWe cannot stress enough the role of insulin in causing and, even more important, maintaining obesity. As little as one (1) microUnit of insulin in the blood can inhibit release of fat from storage, no matter how little is eaten! We are often asked how to tell if one is hyperinsulinemic. The simplest method to determine if you are hyperinsulinemic is to have your fasting insulin levels tested. This means you cannot eat anything for 12 hours prior to having your blood drawn. Most people have their blood drawn in the morning and achieve the 12-hour fast by skipping breakfast. Optimal fasting insulin levels are between 0-3.

Another way of assessing serum insulin levels is to have blood drawn for serum glucose and serum insulin levels at the same time. When the results are obtained, multiply the glucose number (reported in milligrams percent) by 0.41 and then subtract 34. The resulting number is what your insulin level should be (reported in microUnits).

0.41 < Glucose (mg %) minus 34 = Insulin (microUnits)

The best approach is to determine your average 24-hour glucose level by measuring the hemoglobin HbA1c levels. This is hemoglobin that has had glucose residues added to the protein structure over prolonged exposure to high blood concentrations of glucose (Boutati et al. 2004).

APPENDIX G

Calorie RestrictionOver 60 years ago, scientific experiments showed that dietary restriction dramatically increased the life span of rats, as compared with those that were allowed to eat as much as they wanted. One theory is that short-term caloric restriction stimulated an adaptive response to famine that shifted resources away from reproduction and toward self-repair to maintain life. This may involve a change in gene expression that stimulates the production of "stress proteins" and other protective mechanisms (Shanley et al. 2000; Mattson et al. 2001; Van Remmen et al. 2001).

The study of the genetic changes induced by calorie restriction has been the focus of extensive research by Dr. Spindler. Using advanced gene chip technology, Dr. Spindler was able to examine changes in 11,000 genes, including most of the genes involved in DNA repair, antioxidant metabolism, and protein synthesis (Lee et al. 1999).

Moderate calorie restriction has been shown to stimulate several anti-aging mechanisms, including:

Inhibiting programmed cell death (apoptosis) (Mattson et al. 2001) Increasing protein synthesis and turnover (Lambert et al. 2000; Weindruch et al. 2001) Increasing the production of antioxidant proteins resulting in less oxidative damage (Sohal et al. 1996; Lass et al. 1998; Zainal et al. 2000) Stabilizing cellular calcium homeostasis (Mattson et al. 2001) Increasing the secretion of growth hormone (IGH) to normal levels (Sonntag et al. 2000) Increasing the resistance of neurons in the brain to dysfunction and increasing the number of newly generated neural cells in the adult brain (Mattson 2000)

The effects of a calorie-restricted diet on humans were inadvertently conducted on the 4 men and 4 women that lived in Biosphere 2 for 2 years. On the low-calorie, nutrient-dense diet, the men sustained 18% weight loss and the women sustained 10% weight loss, mostly within the first 6-9 months (Walford et al. 1999).

APPENDIX H

The Medical Examination Body Fat Measurement

The Medical ExaminationA well-trained medical physician should be consulted before beginning a weight-loss program. Your physician may do the following:

Take a careful medical history and perform a physical examination. Inquire about your personal weight history, how long you have been overweight, and methods you have used to lose weight in the past. Ask whether you have relatives with illnesses related to overweight, such as Type II diabetes mellitus or heart disease. Evaluate your risk for obesity-related health problems by measuring your blood pressure and performing blood tests.

If your physician determines that you have obesity-related health problems or are at high risk for such problems, and if you have been unable to lose weight or maintain weight loss with non-drug treatment, he or she may recommend the use of prescription weight-loss medications. If your physician is considering using a prescription weight-loss medication, it is important to inform him or her of any of the following medical conditions:

Pregnancy or breast-feeding History of drug or alcohol abuse or eating disorders History of depression or manic depressive disorder and use of monoamine oxidase (MAO) inhibitors or antidepressant medications Migraine headaches requiring medication Glaucoma or diabetes High blood pressure, heart disease, or other heart conditions, such as an irregular heart beat Plans for surgery that require general anesthesia

Body Fat MeasurementThe amount of total body fat can be estimated in several ways:

One simple method is to measure waist circumference at the midpoint between the lower border of the ribs and upper border of the pelvis. The waist to hip ratio is calculated by dividing this measurement (in centimeters) by the circumference of the hips. This is a simple method of measuring abdominal obesity, although it is not very accurate in predicting actual abdominal fat. Skinfold thickness can be measured using specialized calipers. The most common sites to measure are on the arms, legs, back, and abdomen. This method provides more information than the waist to hip circumference, but measurements are often variable, depending on the observer.

Bioelectrical impedance measures body electrical conductance and resistance. Electrodes are placed on the hands and feet and are connected to a special electronic instrument. This method is based on the difference in electrical conductance between fat, lean body mass, and water. This method is simple and practical.

*******************Please feel free to use my other email nvergel@... if you are having problems with my AOL email. Thanks! VergelDirectorProgram for Wellness Restoration, PoWeRA 501 © 3 non profit national organizationpowerusa.orgsalvagetherapies.orgfaciawasting.orgDisclaimerThis information (and any accompanying printed material) is not intended to replace the attention or advice of a physician or other health care professional. Anyone who wishes to embark on any dietary, drug, exercise, or other lifestyle change intended to prevent or treat a specific disease or condition should first consult with and seek clearance from a qualified health care professional.