Life Extension Magazine June 2009
The Nine Pillars of Successful Weight Loss
By William Faloon
By William Faloon
The Life Extension Foundation® has a 29-year track record of identifying novel methods to address the health concerns of aging humans. For example, Life Extension warned long ago that atherosclerosis was caused by more than a dozen independent correctable risk factors, with cholesterol and LDL being only two of them.1
When it comes to weight loss, mainstream medicine has recommended “diet and exercise” for so long that this phrase has become more of a cliché than any kind of momentous scientific communication.
The fact is that aging people need to do a lot more than reduce calorie intake and increase physical activity if they are going to lose and keep off excess body fat.
In this article, we succinctly address the nine steps that most overweight aging people should follow if they are to achieve optimal removal of surplus body fat. This multi-step program is analogous to the “drug cocktails” that doctors now use to control HIV infections in a way that enables patients to live for decades instead of less than one year, as was the case when the disease first manifested.
The Nine Pillars of Successful Weight Loss are also analogous to what progressive oncologists are doing to cure cancer today by administering multiple therapies designed to neutralize the numerous survival mechanisms cancer cells use to escape eradication.
In some respects, the uncontrolled proliferation and size of adipocytes (fat cells) in the aging body is like a benign tumor growing in our abdomens, buttocks, and other areas of the body where it is unwanted.
Just like most Life Extension members understand that they often have to correct several vascular disease risk factors if they are to protect against heart attack and stroke, those seeking to lose weight should consider making many of these Nine Pillars of Successful Weight Loss a regular part of their health-maintenance program.
Pillar Number 1: Restore Insulin Sensitivity
Normal aging causes the insulin receptors on cell membranes to lose their youthful sensitivity or functionality. The result is a pathological condition called “insulin resistance” that impairs the ability of cells to efficiently take up glucose and utilize it for energy production. Glucose not taken up by energy-producing cells prompts the release of excess insulin. Hyperinsulinemia, a condition of high circulating insulin levels, is associated with a significantly increased risk of heart disease. In fact, a recent study showed that patients with heart disease had significantly higher plasma levels of blood sugar and circulating insulin.2
There are several ways to restore insulin sensitivity to our cell membranes. For example, nutrients such as chromium,3,4 magnesium,5 cocoa polyphenols,6 and fish oil7,8 can help.
A low-cost prescription drug called metformin can also significantly enhance insulin sensitivity.9-11 It is approved only as a treatment for type 2 diabetes, but published scientific studies indicate it can help reduce body fat.12 The dose range for those seeking to enhance their insulin sensitivity and reduce body weight can vary from 250 mg three times daily with meals up to 850 mg three times daily with meals. Consult with your prescribing physician to make sure that metformin is right for you. As you will read later in this section, restoring free testosterone to youthful ranges markedly enhances insulin sensi-tivity in aging men.
The absolute most effective way of restoring insulin sensitivity is to reduce calorie intake. Calorie restriction to under 1,500-1,800 calories/day significantly enhances insulin sensitivity, as documented by dramatic lowering of fasting glucose and insulin blood levels.13-17 Even a moderate cutback of excess calories can markedly improve insulin sensitivity.
So the first pillar to successful long-term weight loss should involve a moderate reduction in calorie intake, at least long enough to restore insulin receptor sensitivity to more youthful ranges. The use of nutrients, hormones, and drugs that enhance insulin sensitivity should also be considered. As you probably know already, a lot more than just eating less is needed to lose weight.
Pillar Number 2: Restore Youthful Hormone Balance
Most overweight human beings have suffered the agonies of calorie deprivation (dieting), but have failed to achieve any kind of sustained fat reduction. While eating less addresses some of the underlying causes of weight gain, the high failure rate of dieting is partially attributable to the severe alteration in hormone levels that occurs as part of normal aging.
A large percentage of men today suffer from abdominal obesity—the most dangerous kind of body fat. It is often difficult, if not impossible for aging men to lose inches off their waistline if they are deficient in free testosterone, especially in the presence of excess estrogen.18-20 Low levels of dehydroepiandro-sterone (DHEA) can also contribute to undesirable fat accumulation in men and women.21
A comprehensive blood test panel can reveal free testosterone and estrogen (estradiol) levels so that a physician can prescribe a topical testosterone cream and an aromatase-inhibiting drug (if necessary) to restore a man’s sex hormone profile to a youthful range. The same blood test panel can also detect DHEA blood levels to enable one to take the proper dose of this over-the-counter dietary supplement.
A comprehensive blood test panel should also measure prostate-specific antigen (PSA) in men to help rule out prostate cancer. Those with prostate cancer cannot restore these hormones until the cancer is completely eradicated. Some men are able to reduce excess estrogen while simultaneously boosting free testosterone by taking nutrient formulas that contain plant extracts to help inhibit the aromatase enzyme (which converts testosterone into estrogen) and decrease levels of sex hormone-binding globulin (which binds free testosterone).
A substantial percentage of aging women (and many aging men) have less-than-optimal thyroid levels, thus predisposing them to weight gain. Thyroid hormone is needed to maintain healthy metabolic rates. Those who are deficient in thyroid hormone should be prescribed thyroid medication to maintain or improve their overall health, as well as to provide this hormone involved in the regulation of body composition. Drugs to consider are Armour® natural thyroid complex (containing both T4 and T3) or Cytomel® (containing T3). Trying to lose weight in the face of thyroid hormone deficit can be particularly challenging.
A common problem women experience during menopause is an increase in belly fat mass. Estrogen levels plummet during menopause and some studies correlate this estrogen deficiency with greater abdominal adiposity in women. While excess levels of horse urine-derived estrogen drugs may cause weight gain, evidence suggests that individually dosed natural estrogen replacement facilitates a reduction in abdominal fat in women who are estrogen deficient.22,23 Restoring hormone balance in aging females requires the intervention of a health care practitioner with specialized expertise in prescribing bioidentical hormone replacement therapy. Men are more fortunate in that almost any doctor can prescribe the proper dose of testosterone (and aromatase-inhibiting drugs, if needed).
Pillar Number 3: Control Rate of Carbohydrate Absorption
We already know that too much blood glucose (and the subsequent insulin spike) predisposes people to gaining unwanted fat pounds. By taking just five grams of soluble fiber before or with each meal, one can significantly blunt the glucose-insulin surge.34
Fiber may protect against unwanted weight gain via several mechanisms that involve both effects on satiety and glucose-insulin responses.34-36 For example, research has shown that vegetarians weigh significantly less than non-vegetarians, whether measured by body mass index or body weight.37 Some experts believe that vegetarians’ lower average body weight is linked to one factor: the high fiber content of the plant foods consumed.38 Plant fiber fills you up quickly, and studies indicate that this results in less snacking and binging later in the day.
The Seven Countries Study provides additional evidence linking a high-fiber diet with lower body weight. Researchers found that people living in countries with high fiber intake weighed less than those living in countries where fiber intake is low.39 Higher fiber intake is also associated with lower average body weight in the US. In the famous Nurses’ Health Study, those who ingested more dietary fiber consistently weighed less than those who consumed less fiber.36
Finally, in the Coronary Artery Risk Development in Young Adults Study examining how heart disease develops in adults, researchers linked higher dietary fiber intake with lower body weight and waist-to-hip ratios, along with a reduction in markers of heart disease risk. Higher fiber consumption predicted less weight gain more strongly than did total or saturated fat consumption.38
Not all fibers are created equal. Beta-glucans (derived from oats and barley) are particularly effective in slowing the absorption of carbohydrates—enabling one to control blood sugar levels and induce the satiety needed to achieve healthy weight management. Studies show that when taken with meals, beta-glucan fibers markedly blunt post-meal elevations in blood sugar and insulin levels. Like other foods rich in soluble fiber, beta-glucans help improve blood glucose metabolism while also lowering serum lipid levels.40,41
Getting into the routine of taking five grams of a neutral-tasting beta-glucan fiber mix before or with each meal would help provide weight loss effects via this mechanism (i.e., controlling rate of carbohydrate absorption). Alternatively, taking fiber capsules (containing the highly viscous fiber glucomannan, which promotes healthy glycemic status) before each carbohydrate-rich meal would also help reduce the glucose-insulin surge that contributes to obesity.
Some people with chronic weight control problems will need more than soluble fibers to impede carbohydrate absorption. Carbohydrates contribute to surplus body fat by converting to triglycerides that bloat our adipocytes. Compounds that interfere with complex and simple carbohydrate breakdown and absorption can be important components of a weight loss program.
Alpha-glucosidase inhibitors interfere with the breakdown of simple carbohydrates into glucose. Alpha-amylase inhibitors interfere with the breakdown of large carbohydrate molecules like starch into linked glucose polymers. These simple sugars are then broken down to glucose by the alpha-glucosidase enzyme.
An extract from the white kidney bean (Phaseolus vulgaris) functions as an alpha-amylase inhibitor. In a placebo-controlled study, those taking white kidney bean extract before meals lost 1.5 inches of abdominal fat over an eight week period. An even greater benefit might be seen by taking an alpha-glucosidase and alpha-amylase inhibitor together. Such combinations are available in dietary supplement form. Alternatively, one can be prescribed 50 mg three times a day (before each carbohydrate meal) of the drug acarbose (an alpha-glucosidase inhibitor) and take 1,000 mg of white kidney bean extract (an alpha-amylase inhibitor) before each meal containing carbohydrates.
Pillar Number 4: Increase Physical Activity
Most people think the only weight-loss benefit of exercise is to use up more stored body fat calories. In reality, exercise induces many beneficial changes at the cellular level that contribute to better weight control. Increased physical activity itself improves insulin sensitivity and mimics the effect of certain antidiabetic drugs (such as the PPAR-gamma agonists), which can have a favorable effect on body fat contouring.44
The type and intensity of physical activity will vary considerably among individuals. The purpose of making increased physical activity one of the Nine Pillars of Successful Weight Loss is to encourage everyone seeking to achieve optimal fat loss to engage in some form of increased physical activity.
It is our opinion that people who could follow a good exercise program to keep fat pounds off would do so if they saw rapid and meaningful weight loss results. Even a modest increase in physical activity, as a component of the Nine Pillars of Successful Weight Loss, should produce a reduction of fat mass (especially in the abdomen) remarkable enough to motivate even sedentary individuals to find ways to become more consistently physically active.
Pillar Number 5: Restore Brain Serotonin
When the brain is flooded with serotonin, satiety normally occurs. A serotonin deficiency has been associated with the carbohydrate binging that contributes to the accumulation of excess body fat.50 Obese individuals have low blood tryptophan levels, which indicate that their overeating patterns may be related to a serotonin deficiency in the brain.51,52
In addition, cutting-edge research reveals that chronic inflammation and immune system overactivation appear to play critical roles in obesity.52,53 Inflammatory cytokines like interfeon-gamma are made and released in body fat. An enzyme called indoleamine 2,3-dioxygenase is activated by interferon-gamma, which then degrades tryptophan in the body. Tryptophan is needed to produce serotonin in the brain.
In fact, human studies suggest that obese patients have decreased plasma tryptophan levels that remain low, independently of weight reduction or dietary intake.51,52 This altered tryptophan metabolism reduces serotonin production and contributes to impaired satiety, which in turn contributes to increased caloric intake and obesity.
When obese patients were given 1,000 mg, 2,000 mg, or 3,000 mg doses of L-tryptophan one hour before meals, a significant decrease in caloric consumption was observed. The majority of the reduction in caloric intake was in the amount of carbohydrates consumed and not the amount of protein consumed.54
In a double-blind, placebo-controlled study, obese patients on protein-rich diets who received tryptophan (750 mg twice daily orally) had significant weight loss, compared with a placebo group.55
For 19 years, tryptophan dietary supplements were restricted. The good news is that pharmaceutical-pure tryptophan supplements are once again available to Americans.
Those seeking to embark on a comprehensive weight-loss program should consider adding tryptophan (along with nutrients that inhibit tryptophan-degrading enzymes) to their daily program in starting doses of 500 mg before meals, two to three times per day.
Pillar Number 6: Restore Resting Energy Expenditure Rate
It is often challenging for aging humans to lose significant body fat stores, even when following a low-calorie diet, restoring youthful hormone balance, ingesting fiber, and aggressively exercising. A missing link for successful long-term weight loss is failing to boost resting energy expenditure, i.e., to burn off stored body fat.
Fucoxanthin and pomegranate seed oil have demonstrated interesting effects in enabling aging humans to safely boost their metabolic rate and obtain some fat loss.56,57
Several other natural nutritional agents offer safe and effective means of enhancing metabolic rate: