In people with obesity, weight loss achieved through metabolic surgery was associated with improved outcomes after COVID-19, according to a study published in JAMA Surgery (2021 Dec 29. doi:10.1001/jamasurg.2021.6496).
The finding comes from a retrospective cohort of 5,053 adult patients who underwent weight loss surgery between Jan. 1, 2004, and Dec. 31, 2017, at the Cleveland Clinic Health System and 15,159 propensity score–matched patients who did not have metabolic surgery.
Patients tested positive for SARS-CoV-2 at about the same rate in both groups: 9.1% among surgical patients and 8.7% in the nonsurgical arm. However, individuals who had undergone weight loss surgery had a 49% lower risk for hospitalization, 63% lower risk for need for supplemental oxygen and a 60% lower risk for severe disease during a 12-month period after contracting COVID-19.
The researchers, led by Ali Aminian, MD, the director of the Bariatric and Metabolic Institute at Cleveland Clinic, said the findings “represent the best available evidence on the implications of a successful weight loss intervention for COVID-19 outcomes.”
There is an established link between obesity and poor outcomes after COVID-19 infection. But this study demonstrates that obesity is a modifiable risk factor. By losing weight several years earlier with surgery, patients had a reduced risk for adverse outcomes with COVID-19.
At the time of their COVID-19 diagnosis, patients in the surgical group had achieved 20.0 kg lower body weight and better glycemic control compared with presurgical levels. They’d lost 18.6% more body weight over time compared with patients who didn’t undergo surgery.
Patients with substantial and sustained weight loss “were likely physically and physiologically better equipped to cope with an infection that has the potential for multiorgan involvement,” the authors concluded.
Three-fourths of patients were female; they were a mean age of 46 years. The study excluded anyone with a history of organ transplant, cancer or precancerous diagnosis, alcohol use disorder or alcohol-related medical condition, dialysis, ascites, cardiac ejection fraction less than 20%, HIV, peptic ulcer disease, or a recent emergency department admission before surgery.
The study has significant limitations due to its retrospective design, including unknown confounders, misclassification bias, patients lost to follow-up and control selection bias. Moreover, the study did not compare patients who were actively pursuing medical or behavioral interventions for obesity. It shows only that successful weight loss can be protective against severe COVID-19 complications.
In an invited commentary, Paulina Salminen, MD, PhD, of the Department of Surgery at the University of Turku, in Finland, and her colleagues argued that metabolic surgery should be considered medically necessary (JAMA Surg 2021 Dec 29. doi:10.1001/jamasurg.2021.6549).
At many places around the country, weight loss surgery is classified as an elective procedure and was put on hold during surges of COVID-19 to preserve scarce healthcare resources.
“As the COVID-19 pandemic continues, health care professionals who make decisions regarding health care use must acknowledge the cumulating evidence of obesity as a modifiable disease that is a predisposing factor for COVID-19 infection, as supported by this current study,” Dr. Salminen and her colleagues wrote.
In June 2020, the American Society for Metabolic and Bariatric Surgery issued a statement, saying metabolic and bariatric surgery should not be considered elective (Surg Obes RelatDis 2020;16[8]:981-982).
The organization said these operations are “medically necessary and the best treatment for those with the life-threatening and life-limiting disease of severe obesity.”
Are you struggling with pain in your feet, legs, or hands from diabetic neuropathy? This is an especially frustrating condition that is both under-assessed and undertreated. And for those that do seek relief, it’s typical to have to try many different treatments before hitting on a combination that works.
Diabetic neuropathy pain is exactly the sort of condition where you might need the wisdom of people that have been there before. We reviewed more than a hundred comments in our Facebook group and forum to get an idea of how our community, made up of regular people with diabetes, deals with this problem.
This article will explore both the mainstream science of neuropathy pain mitigation and the everyday advice of Diabetes Daily community members.
What is Diabetic Neuropathy?
Diabetic neuropathy is a type of nerve damage common in people with diabetes. Neuropathy can affect many parts of the body, including the digestive system, the heart, the eyes, the bladder, the sweat glands, and sexual organs.
The nerve damage that mostly affects the feet, hands, legs, and arms is referred to as peripheral neuropathy. This condition is often very uncomfortable, with patients feeling pain, tingling, burning, prickling, numbness, and complete loss of feeling in the extremities. The pain may be worse at night. These symptoms are generally noticed first in the feet.
Diabetic neuropathy, like other diabetes complications, is ultimately caused by chronic high blood sugars. If you’ve begun to notice the pain associated with this condition, you should visit your doctor or endocrinologist soon. Diabetic neuropathy may indicate that you are also at risk of other serious complications.
Blood Sugar Control
If there’s one treatment for neuropathic pain that the Diabetes Daily community can wholeheartedly endorse, it is optimal blood sugar control.
Diabetic neuropathy is primarily caused by high blood sugar. Achieving a lower, healthier blood sugar is the best way to address the root cause of neuropathy, and may offer both short- and long-term relief. It is unclear if nerve damage can be reversed, but further damage can be prevented through superior blood sugar control.
If there’s another good reason to prioritize blood sugar control, it’s the fact that diabetic neuropathy is an early warning sign of some very dangerous diabetes complications. The feet of a patient with neuropathy may be less capable of healing wounds, which can ultimately “lead to limb compromise, local to systemic infection, and septicemia, and even death.” Several of our community members have had terrifying battles with septicemia.
Prescription Drugs
Don’t hesitate to speak to your doctor about prescription medication for this condition. Pharmaceuticals don’t work for everyone, but they might work for you.
In our community, the most popular pharmaceutical treatment seems to be gabapentin (Neurontin). Gabapentin is an oral prescription medication that acts on the brain, changing the way that it perceives pain. It is also used as an anti-convulsant, to prevent seizures in patients with epilepsy and related conditions.
Your doctor is likely to start you on a low dose, and you may need to increase that dose in order to feel an effect, or if the condition gets worse.
Gabapentin doesn’t work for everyone. A rigorous study found that only 35% of study participants enjoyed significant pain reduction, compared to 21% who were given a placebo, and that “over half of those treated with gabapentin will not have worthwhile pain relief.”
Gabapentin can have side effects, including skin issues, dizziness, and drowsiness. A small minority of users experience intense mood changes that may include suicidal thoughts.
Lyrica (pregabalin) may be the second most popular drug neuropathic pain in our community. Lyrica is related to gabapentin, belonging to the same class of anti-convulsants.
The evidence suggests that Lyrica and other pregabalins have a similar impact to gabapentin. A large review concluded that “Some people will derive substantial benefit with pregabalin; more will have moderate benefit, but many will have no benefit or will discontinue treatment.”
The American Academy of Neurology (AAN) officially recommends three other types of drugs for the treatment of diabetic neuropathy. These three are less commonly prescribed, and as a result, are less commonly discussed in our community:
Serotonin-norepinephrine reuptake inhibitors (SNRIs), including duloxetine, venlafaxine, and desvenlafaxine. SNRIs are anti-depressants that are prescribed for a variety of mental health issues, including anxiety and obsessive-compulsive disorder. They can be effective in reducing neuropathic pain and, as a bonus, may improve mood and other quality of life factors.
Tricyclic antidepressants (TCAs), such as amitriptyline, nortriptyline, and imipramine. TCAs are also anti-depressants, and have been used for decades. TCAs are considered “effective” in the treatment of neuropathic pain, but are associated with side effects, including weight gain.
Sodium channel blockers (such as carbamazepine, oxcarbazepine, lamotrigine, valproic acid, lacosamide). Like gabapentinoids (including gabapentin and pregabalin), these drugs are used to prevent seizures. Sodium channel blockers are not often prescribed, perhaps due to the likelihood of side effects, but the AAN has concluded that they have a similar ability to reduce pain as the preceding drugs.
The AAN believes that the drugs named above are of roughly similar effectiveness, and that doctors should therefore make their recommendations based on “potential adverse effects, patient comorbidities, cost, and patient preference.”
The other important thing to note here is that none of these drugs is perfectly effective, and that doctors are completely unable to predict which drugs will work for which patients. Diabetic neuropathy is a mysterious condition, and experts don’t completely understand why drugs do and don’t work to reduce pain. It may take many months of experimentation with a series of pharmaceuticals to find a pill and a dose that works for you.
Finally, a word about opioids. These powerful painkillers are, in fact, the most commonly-prescribed treatment in the United States for diabetic neuropathy. However, they are not popular in the Diabetes Daily community. That may be for the best: experts from the AAN believe that the drugs should not be prescribed for this type of chronic pain. It seems that most doctors are unaware of that recommendation; a distressing 2020 study in the journal Pain found that most patients are prescribed opioids “before trying even one guideline-recommended medication for peripheral neuropathy,” and that far too many patients end up on chronic opioid therapy. The dreadful impact of opioid addiction is by now very well-known.
Mental Health and Sleep
It may sound surprising, but the American Academy of Neurology actually recommends that people with pain from diabetic neuropathy should seek treatment forsleep and mood disordersfirst, before they explore pain-relieving medication.
While mood or sleep improvements do not actually address the root cause of painful diabetic neuropathy, they do significantly alter our perception of pain.
It stands to reason that a well-rested and happy person is better equipped to deal with chronic pain. If that sounds too obvious, consider that people with diabetes suffer from both depression (and related mental health issues) and sleep disorders far more frequently than average, and that these conditions far too commonly go unrecognized and untreated.
The next time you see your healthcare provider, consider whether you should be discussing your sleep and mental health, in addition to your neuropathy pain and discomfort.
Topical Treatments
There is a bewildering variety of over-the-counter creams and sprays available for neuropathy pain. Experts are optimistic about the use of topical treatments, but scientific proof of their efficacy is a bit murky.
In the AAN guidance, four topical treatments were rated as “possibly more likely than placebo to improve pain.” Those treatments are:
Capsaicin
Nitrosense patches
Citrullus colocynthis
Glyceryl trinitrate spray
A different recent review identified many more chemicals that may be helpful, including even botox injections. This second review highlighted lidocaine and capsaicin patches as two therapies with particularly good data supporting their efficacy.
One brand that our community likes is Biofreeze, which uses menthol as its active ingredient. Biofreeze is available in many different application forms, including sprays, gels, patches, and wipes.
But to put it simply, nobody really knows which topical treatments work best, and what works for you may not work for someone else. It will probably take trial and error to find a product you like. We encourage you to work with your doctor to find good options.
Exercise
Exercise is a tricky subject for some people with neuropathic pain, because a workout itself may trigger that pain. There is also the fear that exercise is likely to cause problems for people with sensitive feet.
However, there is evidence that exercise is healthful for those damaged nerves. A 2014 review concluded that “it is critical to understand that routine exercise may not only help prevent some of those causes [of neuropathic pain], but that it has also proven to be an effective means of alleviating some of the condition’s most distressing symptoms.” And experts have argued that the benefits of exercise outweigh the risk of foot injuries.
Exercise can also be an important part of a holistic treatment plan for diabetic neuropathy. Even low-intensity exercise is known to help lower both blood sugar and cholesterol, prevent weight gain, and improve both mood and sleep, all of which means it will help combat both the root causes of neuropathic pain and your ability to tolerate pain.
Cannabis and CBD
When polling the Diabetes Daily community, perhaps the biggest surprise was how enthusiastically so many of our readers endorsed cannabis for neuropathic pain relief. Many have ranked it as their favorite way to alleviate or cope with the pain and discomfort.
Indeed, there is some evidence that cannabis can be effective. A small 2015 study found that “inhaled cannabis demonstrated a dose-dependent reduction in diabetic peripheral neuropathy pain.” A follow-up by the same team found a similar result.
Generally speaking, experts are somewhat hesitant. In 2021, the International Association for the Study of Pain announced that, due to a lack of good scientific evidence, it could not endorse the use of cannabis for pain relief. The organization also noted that there are important research gaps and much work to be done.
If medicinal-use cannabinoid products are allowed in your area, your doctor may be happy to write you a prescription. If adult-use cannabis is allowed, you don’t need a prescription. Nevertheless, please be aware that the legal status of cannabis use remains confusing in the United States. It is illegal at the federal level, but a gray area is increasingly emerging, for both medicinal and recreational use, as more and more states pass new legislature.
To learn more about cannabis and diabetes—including blood sugar effects and a special warning for patients with type 1 diabetes—please read our article, Marijuana and Diabetes, What You Need to Know.
Some of our community members also recommend CBD oil, either consumed or applied directly to the skin. Most medical authorities believe that the evidence in favor of CBD oil is extremely thin, and caution patients to be wary of anecdotes and marketing claims. Is CBD oil just snake oil? It’s impossible to say. Some of our community members believe it works, and there is some evidence that CBD oil can reduce neuropathic pain.
Elevating Feet
It is the feet, more than any other body part, that suffer most from peripheral neuropathy. Diabetes can lower the blood flow to the feet, which leads to all manner of issues, including slower wound healing and increased risk of infection.
Inadequate blood flow may contribute to nerve damage and pain in the feet. Elevating your feet may bring some pain relief.
When practical, put your feet up while sitting. Be sure to stand up, stretch your legs, and wiggle your feet and toes every once in a while. If the tingling, burning, and pain are at their worst when you’re in bed, experiment with elevating your feet by resting them on a pillow, even while you sleep.
Soaking Feet
Many people with diabetic neuropathy find fast relief from a good bath. Some go a step further, and include Epsom salts in their soaking ritual.
A 2020 study found that an electrical foot bath filled with saltwater offered significant pain reduction. (The warm water bath without salt had no effect).
But it is important to know that major diabetes authorities disagree with this advice, in part because a long soak may not be great for patients with vulnerable feet. The American Diabetes Association very plainly states: “don’t soak your feet.” If your feet are prone to slow-healing wounds, it may be wise to be careful with this remedy.
Compression Socks
Opinions differ on the wisdom of wearing compression socks. Some sources claim that these socks, which gently squeeze the lower legs, promote healthy blood flow. Others claim the exact opposite and say that compression socks restrict blood flow.
Compressions socks are most popular among people with diabetes that have foot and leg swelling issues. Studies have found that compression socks are effective in treating lower leg edema (swelling) without compromising circulation. We were not, however, able to find any published studies evaluating compression socks and pain from diabetic neuropathy.
Some of our community members find them useful for the treatment of neuropathic pain, but many experts think they’re a bad idea for people with diabetes. The National Institutes of Health tells people with diabetes foot issues: “do not wear tight socks.”
Alpha Lipoic Acid
Alpha lipoic acid (ALA) is a fatty acid and antioxidant that is found both in the human body and in many foods. It’s been proposed as an alternative treatment for many conditions, including neuropathic pain.
Several of our community members take ALA supplements (they should be easy to find in most pharmacies). ALA is theorized to improve “nerve blood flow, nerve conduction velocity, and several other measures of nerve function.” And there is some scientificevidence that ALA really does help to relieve neuropathic pain.
B Vitamins
B vitamins have a complex relationship with the human nervous system; too little or too much of certain B vitamins can directly cause nerve damage.
Some Diabetes Daily readers take a B vitamin supplement, and believe that it helps with their neuropathic pain. The science, though, is unclear. A review of 13 studies concluded that “the evidence is insufficient to determine whether vitamin B is beneficial or harmful,” but that the supplements were “generally well-tolerated.” There is some weak evidence that vitamin B12 may be helpful.
Massage
Whether they do it themselves, persuade a loved one, or hire a professional, several of our community members find relief from massage. Although the science on this isn’t exactly settled, a quick google search will show that there are many protocols out there for massage for pain relief from neuropathy.
We identified twostudies that found significant pain reduction from aromatherapy massage, although it’s unclear if the aromatic oil or the massage was the critical element, or if they’re both necessary for relief. A 2016 study found that “Thai foot massage” achieved significant results, and a large 2019 meta-analysis found that Chinese acupressure massage, when combined with a Chinese medicinal footbath, also offered improvement.
Of course, you don’t really need a randomized controlled trial to know if a little foot rub feels good. This can be considered a nonpharmaceutical therapy with few downsides, one that is well worth a try.
When Nothing Works
Unfortunately, some of our community members have never found anything that helps relieve their pain. If that’s the case, we encourage you to re-prioritize blood sugar control and consider lifestyle changes that can promote stress reduction and good mental health.
There are also many resources out there for people that deal with chronic pain, such as the U.S. Pain Foundation, which has a wealth of information on coping mechanisms and self-management techniques. As the American Psychological Association states, “Mental and emotional wellness is equally important—psychological techniques and therapy help build resilience and teach the necessary skills for management of chronic pain.”
Takeaways
There are no easy answers for pain from diabetic neuropathy. Patients that do find some relief often use a combination of prescription medication, over-the-counter treatments, and non-medicinal techniques such as massage or foot elevation. Good blood sugar management is the only therapy that addresses the root cause.
If you have neuropathic pain, please seek treatment from a medical professional soon. The problem is better addressed sooner than later, and it may take some experimentation to find what works for you.
A new expert guidance states that people with pain from diabetic neuropathy should seek treatment for sleep and mood disorders first, before they explore pain-relieving medication.
The new advice comes from The American Academy of Neurology (AAN), the leading professional society of neurologists and neuroscientists.
In treating patients with [painful diabetic neuropathy], it is important to assess other factors that may also affect pain perception and quality of life… Mood and sleep can both influence pain perception. Therefore, treating concurrent mood and sleep disorders may help reduce pain and improve quality of life, apart from any direct treatment of the painful neuropathy.
An accompanying press release stated, “a doctor should first determine if a person also has mood or sleep problems since treatment for these conditions is also important.”
Diabetic neuropathy is a type of nerve damage common in people with diabetes. Neuropathy can affect many parts of the body, including the digestive system, the heart, the eyes, the bladder, the sweat glands, and sexual organs.
The nerve damage that mostly affects the feet, hands, legs, and arms is referred to as peripheral neuropathy. This condition is often very uncomfortable, with patients feeling pain, tingling, burning, prickling, numbness, and complete loss of feeling in the extremities. Pain may be worse at night. These symptoms are generally noticed first in the feet.
To put it simply, while mood or sleep do not actually address the root cause of painful diabetic neuropathy, they do significantly alter our perception of pain.
It stands to reason that a well-rested and happy person is better equipped to deal with chronic pain. If that sounds too obvious, consider that people with diabetes suffer from both depression (and related mental health issues) and sleep disorders far more frequently than average, and that these conditions far too commonly go unrecognized and untreated.
Not only do disordered sleep and mental health issues have a direct negative effect on pain tolerance and overall health, but they also negatively impact glycemic control. Because diabetic neuropathy is ultimately caused by high blood sugars, addressing sleep and mood problems can create a virtuous cycle of improvement.
For patients that require pharmaceutical relief, there are many options available. The new guidance directs doctors to offer one or more of the following prescription medications:
Some of these drugs also have benefits for mood and sleep, which may partially explain how they work.
There are also many topical treatments for peripheral neuropathy, although the scientific proof of their efficacy is a bit murky. In the new AAN guidance, four treatments were rated as “possibly more likely than placebo to improve pain.” Those treatments are:
Capsaicin
Nitrosense patches
Citrullus colocynthis
Glyceryl trinitrate spray
Another treatment people have found effective is exercise. A 2014 review concluded that “it is critical to understand that routine exercise may not only help prevent some of those causes [of neuropathic pain], but that it has also proven to be an effective means of alleviating some of the condition’s most distressing symptoms.” As a bonus, exercise is known to improve both mood and sleep, which means it should also help reduce the perception of pain, as explained above.
Like other complications, nerve damage is ultimately caused by chronic high blood sugar. About half of people with diabetes develop nerve damage. It can happen at any time but chances of developing nerve damage go up with age and the longer a person has diabetes. It is also more common in patients with obesity, high cholesterol, and high blood pressure. But it is never too late to improve blood sugar control.
The next time you see your healthcare provider, consider whether you should be discussing your sleep and mental health, in addition to your neuropathy pain and discomfort.
People sometimes ask me, “What’s the most important thing to do if you’re diagnosed with type 2 diabetes?’
My answer: “TAKE THIS DISEASE SERIOUSLY.”
Well, actually, I don’t usually shout, but I sometimes want to. If you’re reading this, then I think you’re taking this disease seriously, trying to learn as much as you can about it so you can control it.
But too many people don’t. They want the doctor to give them a pill so they can go on exactly as they have in the past, eating too much, especially foods that make their blood glucose (BG) go up, and getting no exercise.
One problem in type 2 control is that the results of not controlling well aren’t immediate. You won’t break out in blue spots if you eat a big piece of chocolate cake with ice cream. Your hair won’t turn pink if you eat a huge pile of mashed potatoes and gravy with Texas toast on the side. Some people feel bad when they have high BG levels. Others don’t.
I was diagnosed with fasting levels in the 300s, and I went into the 400s after meals. But I felt fine.
No, the effects of high BG levels are insidious. The glucose gloms on to various substances in your body and eventually causes complications. The damage from the glucose can result in cataracts, retinopathy that can lead to blindness, neuropathy that can make your feet hurt all the time, vascular problems that lead to heart attacks, amputations, impotence, kidney disease, and more.
None of these complications are pleasant. But if you take this disease seriously and control your BG to normal or near-normal levels, the chances that you’ll get complications are low.
It’s not easy. Watching your friends pig out at an ice cream stand while you drink a cup of black coffee, no sugar, isn’t fun. Different people have different ways of dealing with this. Some can eat just a couple of spoonfuls of some treat and leave the rest. Others find it works best to avoid the treats altogether. I’m in the latter group. If I ate a couple of spoonfuls of some treat, I’d crave it all. When I haven’t eaten bread, cake, and ice cream for years, I no longer want them, even if all around me are eating them.
This situation of not wanting the treats isn’t instantaneous. It takes a while before you can deal with these situations easily. But persistence pays off.
Well, I’d rant on and on, but right now I’m craving a lamb chop with broccoli and butter, so I’d better go.
Anticoagulant or antiplatelet therapy can be continued during the perioperative period in patients having facial plastic surgery without increased risk of serious complications, according to a large observational study.
Dr. Jeffrey S. Moyer, Chief of Facial Plastic and Reconstructive Surgery at the University of Michigan believes the results will lead to a “change in clinical practice for many physicians since discontinuing aspirin or coumadin is fairly standard for many surgeons performing these types of procedures,” he told Reuters Health.
Dr. Moyer and colleagues analyzed complication rates in 320 patients who underwent facial plastic surgical procedures while receiving antiplatelet and/or anticoagulant therapy (aspirin, clopidogrel, or warfarin), compared to a matched control group of 320 patients who did not receive this therapy in the perioperative period.
According to their report online now in JAMA Facial Plastic Surgery, 42 patients (13.1%) who used anticoagulant or antiplatelet medication perioperatively had at least one complication compared with 52 (16.2%) control patients who did not. Five patients in each group had a severe complication (1.6%).
Patients on aspirin at the time of surgery were not more likely than controls to have a complication (odds ratio 0.73). Patients on aspirin and clopidogrel also didn’t have increased complication rates.
“This finding is consistent with most publications, which have found that aspirin can be safely continued during the perioperative period with no significant increase in complications in patients who undergo various cutaneous surgical procedures,” the investigators say.
Patients taking warfarin did have an increased risk for perioperative bleeding and postoperative infections (odds ratios 3.80 and 7.29, respectively). None of the patients who were taking warfarin plus aspirin had complication rates that reached statistical significance owing to small numbers in this group, but there was a “strong trend” toward more complications, the investigators say.
However, they didn’t see any increase in serious complications, such as flap necrosis, dehiscence, or return to the operating room, in patients taking warfarin in the perioperative period.
“The decision as to whether to discontinue antiplatelet or anticoagulant medications involves an assessment of the qualitative or quantitative risk involved with continuation vs discontinuation of these medications,” the investigators acknowledge in their article.
Dr. Moyer told Reuters Health, “The findings that there were no increases in complications with aspirin or serious complications with coumadin (though bleeding and infection rates are higher with coumadin) suggests that continuing these medications could limit the much more serious complications associated with discontinuing aspirin or coumadin (for example, stroke or death).”
“Patients who are taking multiple agents should be weaned to a single agent, if possible, given the likely increased risk of complications in this population,” the investigators add in their article.
In life we take many things for granted. People are told to go on a low fat diet and do some aerobic training, and yet they still gain body fat. Your blood work shows slightly altered cholesterol and thyroid levels and right away you’re told to go on medication. The trainer at your local gym rips out a copy of Everyday Stretches (reproduced from a 1987 poster) and says: “Do this before your next workout.”
If you’ve been spinning your wheels and going nowhere in your pursuit for optimal health and fitness, then stop! Doing something simply because you’ve been told to is not good enough.
It’s time to question authority and challenge the establishment!
Five Common Health and Fitness Misconceptions
Let’s start by dispelling five common health and fitness misconceptions. Dare I suggest that…
1.A high fat intake can actually lower body fat!
Two reasons: a) If low fat is consumed, your body retains body fat as a protective/survival mechanism, and b) a high fat intake upregulates key (lipase) enzymes, which not only break down dietary fat but also body fat.
Of course, a high fat and high carb diet will result in body fat accumulation so this only applies to a low carbohydrate intake.
“The lipase enzyme is a naturally occurring enzyme found in the stomach and pancreatic juice, which is also found within fats in the foods you eat.
Lipase enzyme digests fats and lipids, helping to maintain correct gall bladder function. As such, these constitute any of the fat-splitting or lipolytic enzymes, all of which cleave a fatty acid residue from the glycerol residue in a neutral fat or a phospholipid. The lipase enzyme controls the amount of fat being synthesized and that which is burned in the body, reducing adipose tissue (fat stores).
The lipase enzyme belongs to the esterases family of proteins. The lipase enzyme is found widely distributed in the plant world (beans and legumes), as well as in molds, bacteria, milk and milk products, and in animal tissues, especially in the pancreas.
In sufficient quantities of lipase enzyme production, lipase can help use fat-stores to be burned as fuel. Indeed, lipase is a rate-determining enzyme, which not only activates the burning of stored body fats but also effectively inhibits fatty acid synthesis, or fat storage!
Hormone-Sensitive Triacyclglycerol Lipase, as it is also known, actually stimulates lipolysis in fat tissues, safely raising blood fatty acid levels, which ultimately activates the beta-oxidation pathway in other tissues, such as liver and muscle. In the liver, lipolysis leads to the production of ketone bodies that are secreted into the bloodstream for use as an alternative fuel to glucose by peripheral tissues.”
2.Reduced thyroid levels (i.e. TSH levels above 5) for a lean individual following a low-carb diet may be normal and healthy!
Now before you throw your chair at the computer, hear me out. As Dr. Ron Rosedale notes in the excerpt below, reduced thyroid levels are not necessarily synonymous with hypothyroidism. Your body chooses to lower thyroid hormones due to an increased efficiency of energy use and hormonal signaling. It is yet another example of how your body adapts and should not be viewed as abnormal.
The knee-jerk reaction in many cases would be thyroid medication, which could potentially decrease your lifespan.
“Metabolic rate and temperature has long been connected with longevity. Almost all mechanisms that extend lifespan in many different organisms result in lower temperature. Flowers are refrigerated at the florist to extend their lifespan. Restricting calories in animals also results in lower temperature, reduced thyroid levels, and longer life.
It should be noted that reduced thyroid levels in this case are not synonymous with hypothyroidism. Here, the body is choosing to lower thyroid hormones because the increased efficiency of energy use and hormonal signaling (including perhaps thyroid) is allowing this to happen.
Anything will dissolve faster in hot water than cold water. Extra heat will dissolve, disrupt and disorganize. This is not what I try to do to make someone healthy. It is commonly advised to increase metabolism and increase thermogenesis for health and weight loss.
Yet how many of you would put a brand of gasoline in your car that advertised that it would make your engine run hotter? What would that do to the life of your car? It is not an increase in metabolism that I am after; it is improved metabolic quality.”
3.Low cholesterol levels will promote aging.
Cholesterol is the raw material for many hormones. If you lower your cholesterol you will also lower your hormone production … and if you lower hormone production, you increase aging! To make matters worse, low cholesterol has been associated with a broad complex of emotional, cognitive and behavioral symptoms including aggressiveness, hostility, irritability, paranoia, and severe depression.
There is also an increase in deaths from trauma, cancer, stroke, and respiratory and infectious diseases among those with low cholesterol levels.
Furthermore, a study in the British medical journal, Lancet, indicates that elderly men die earlier with low blood cholesterol levels.
“The human organism is in a state of dynamic equilibrium, know as homeostasis. One of the main roles in normal homeostasis belongs to multiple feedback loop mechanisms.
Cholesterol is the precursor or the building block for the basic hormones: pregnenolone, DHEA, progesterone, estrogen, testosterone.
Deterioration of the reproductive function, one of the most striking endocrine alterations occurring in aging, is related to a complex interplay of factors. Target organs may become less sensitive to their controlling hormone or may break them down at a slower rate. Hormone levels may change; some increasing, some decreasing and some remaining unchanged.
Many of the diseases that middle-aged persons begin experiencing including depression, abdominal weight gain, prostate, breast and heart disease, are directly related to hormone imbalances.
Conventional doctors are prescribing drugs to treat depression, elevated cholesterol, angina and other diseases that may be caused by hormone imbalance.
A few years ago we found out that some patients who had high cholesterol levels before hormonorestorative therapy (HT) were free of cholesterol problems during therapy. We started pondering as to why this had happened?
In our opinion, when the production of hormones starts to decline our body tries to correct this problem by increasing the production of cholesterol. A similar situation happens to women during pregnancy. When a female’s body needs more hormones for herself and her baby, cholesterol levels are elevated significantly. If a woman’s body is unable to increase the production of cholesterol the risk of an abortion and miscarriages is increased.
Another situation is a low level of cholesterol. If your total cholesterol is less than 160, you have nothing to worry about. Wrong opinion!
A low level of cholesterol means a low production of basic hormones (because of a limited amount of building blocks). Patients with a low level of hormones have life problems that include suicides, criminal behavior, depression, attention deficit disorder, cancer at young age, etc. Low cholesterol is a marker for poor underlying health.
When patients take cholesterol-lowering drugs (CLD) we can surmise that hormonal production will decrease. That’s why many patients on CLD have severe fatigue, fibromyalgia-like pain, depression, high risk of cancer, suicides, weight gain and impotency.
Normally our body tries to keep a normal ratio between different hormones: DHEA/cortisol, estrogen/progesterone, female/male hormones. When we have a malfunction in a feedback loop mechanism we start to have the problems related to the imbalance of hormones (for example: male or female dominance, estrogen dominance, etc.).
Once again, when the production of hormones starts to decline, our body tries to correct the deficiency of hormones by the extra production of cholesterol. It looks like the elevation of total cholesterol serves as a compensatory mechanism for hormonal deficiency.”
Specifically, long distance, low intensity, rhythmic-type aerobics done for a long duration/distance on a frequent basis can signal your body to store fat.
Your body prefers fat for fuel at lower intensities. It adapts to aerobic activity by storing fat (usually in the hips and thighs) to become more efficient for future use. The more fat you store, the more you can use.
Furthermore, aerobics are associated with increased cortisol levels without a concomitant increase in testosterone (as occurs during strength training) disrupting an optimal testosterone:cortisol ratio. In fact, average testosterone levels are significantly lower in endurance athletes. This, of course, equates to a decrease in muscle and strength along with an increase in (android) body fat, i.e., midsection fat.
5.Static stretching will make you weak.
This has been well documented in the literature, and yet a typical warm-up usually contains some form of (you guessed it) static stretching. The classic Bob Anderson style of stretching before exercise tends to sedate muscles, and research shows that it will decrease power and strength by as much as 30 percent for up to 90 minutes. By that time, your workout is over!
Sometimes you need to take a sledgehammer and crush what’s written in stone!
We’ve been told to reduce fat in our diets, lower our cholesterol levels, improve reduced thyroid production with medication, perform aerobic training almost daily, and definitely start each workout with some static stretching.
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