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Older Bolder Foundations

Metabolic Syndrome: Diagnostic Criteria and More

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Yesterday I shared a bit about the metabolic syndrome (scroll down to read), the constellation of risk factors that are deemed to represent a critical risk for developing other serious medical issues over time – including cardiovascular (heart) disease, cerebrovascular (i.e. strokes), diabetes, and several more.

Let’s take a more detailed look today at the diagnostic criteria for the metabolic syndrome and the most common symptoms it produces.

Diagnosing the Metabolic Syndrome

By the standard criteria in place today, you’re considered to have the metabolic syndrome if you have at least three of these five key criteria:

Waistline measurement of > 40 inches for men, > 35 inches for women.

Fasting triglyceride level above 150 mg/dl.

HDL (high density lipoprotein) level < 40 mg/dl for men, <  50 mg/dl for women.

Fasting blood glucose level > 100 mg/dl OR are taking glucose-lowering meds.

Blood pressure 130/85 or higher OR are taking meds to lower your blood pressure.

While not considered a diagnostic criteria, many people also have the skin changes of acanthosis nigricans (darkened skin under the arms or on the back of the neck) or skin tags.

Common Symptoms of the Metabolic Syndrome

Somewhat ironically, there aren’t any immediate symptoms associated with development of the metabolic syndrome; these changes develop over time, allowing our often over-developed sense of personal denial to strengthen as well.

An expanding waistline is surely a readily visible sign, particularly when it’s prominently deposited on the trunk and abdomen, though a person could be “skinny as a rail” and still have hypertension (high blood pressure), a high fasting blood sugar, high triglycerides, low HDL and be labeled as having the metabolic syndrome.

If in doubt, consult your physician, assess your risk factors with simple lab analysis, and chart your course for recovery.

Steps to take in dealing with a “diagnosis” of the metabolic syndrome will follow.

Metabolic Syndrome: What Is It?

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Yesterday I had the pleasure of sitting down with a delightful couple here in the DFW metro for coffee and a chat about their coaching needs.

The wife had recently been scolded by her physician and told “she was a walking metabolic syndrome disaster”, and left to an apparently under-equipped physician’s assistant to discuss it further, which consisted by report of being handed a three-page pamphlet and being told to “lose weight or you’ll need a (weight loss) surgery…”.

They were (quite reasonably) aghast at the interaction, and intimidated by what her “metabolic syndrome” implies. What follows here is meant to serve as a quick introduction to the issue, not an exhaustive discussion in critical detail.

So Just What is the Metabolic Syndrome?

At the most basic level, the metabolic syndrome is the name given a group of risk factors that increase an individual’s risk for a number of bad actors, for example, both cardiovascular (heart) and cerebrovascular (stroke) disease as well as diabetes.

The American Heart Association estimates that as many as 34% of American adults currently meet the criteria to have the metabolic syndrome, an astounding number when you think about. On the other hand, when you ponder how overweight and inactive a large portion of the population actually is, perhaps it shouldn’t be all that surprising.

While not part of the absolute diagnostic criteria for the metabolic syndrome, most authorities (correctly) implicate insulin resistance, a frustrating consequence of eating the Standard American Diet for many, in the development of the metabolic syndrome.

Not all physicians agree that the metabolic syndrome should be viewed as a distinct condition, and you might hear or read it described by other names, including the mysterious sounding Syndrome X, the insulin resistance syndrome, and the dysmetabolic syndrome.

Metabolic Syndrome Risk Factors

There are host of risk factors for developing the metabolic syndrome, here are some of the most common:

Overweight/Obese. Living above your ideal body weight, particularly with abdominal fat stores, is a major risk factor.

Age. Similar to many other health bugaboos, risk increases with age. Life choices in your 30’s really do matter; by age 60, the risk of developing a metabolic syndrome tops 40%.

Diabetes. Risk for developing metabolic syndrome goes up with a family history of T2 diabetes or having developed gestational diabetes during pregnancy for women.

Race. At least in the United States, Mexican-Americans, African-Americans, Asians, and Native Americans are considered to have higher risk.

Sex. Women have a slightly higher risk of developing metabolic syndrome than men.

Smoking. While perhaps not directly causal in the metabolic syndrome, tobacco use clearly worsens the health consequences.

Insulin resistance. A critical and expansive topic to be covered on its own; it must be included on any list of metabolic syndrome risk factors.

Other medical conditions: Non-alcoholic fatty live, polycystic ovary syndrome, cardiovascular disease, certain types of biliary disease (gallstones), lipodystrophy, and more.

Tomorrow we’ll take a quick look at the diagnostic criteria for the metabolic syndrome.

Another 2019 Older Bolder Challenge: Stop Using, and Thinking About, the D-Word

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Today we’re back with another of our Older Bolder Challenges for 2019 – it’s time to stop using, and thinking about the D-Word: Diet.

A point of order regarding the use of the word diet is called for here. In the medical and clinical arenas, the term diet is commonly used to describe a patient’s (or client’s) comprehensive nutritional plan (i.e., specifying the number of calories or other restrictions, such as a 1600 cal ADA diet, etc.).

In common, everyday, non-medical jargon, the word diet is most often used to describe a change from one’s typical eating plan, for example, “I’m trying the vegan, ice tea, prune diet” this January…

Though the approach following might seem almost tongue-in-cheek, I’d argue it’s high time we stopped using the D-word for five key reasons.

The D-Word Implies Deprivation

Admit it, if you’re like most of us (and not a medical-oriented clinician), when you hear the word diet you immediately think about being deprived of the foods you crave. The typical use of the word diet is to suggest a short-term, transient, restrictive eating plan that you endure to accomplish a goal, typically weight loss, and then go right back to the way of eating that got you into trouble in the first place.

The D-Word is Discouraging

Coupled closely to the deprivation issue above, many people starting their New Year, new body diet in January quickly become discouraged, particularly if they’ve chosen a restrictive, bland or very repetitive, or unhealthy plan to follow.

I have a relative who, during my childhood, would go on a several week binge of eating nothing but stewed cabbage every meal for two to three weeks at a time. They’d drop a few pounds (of course, calorie restriction works over the short haul), but eventually became so discouraged, as did the rest of household (cough, gag, etc…), the plan would crash and burn.

The D-Word is Distracting

Fad diets are fascinating to watch; there’s a never ending cascade of new and miraculous diet approaches being hawked by Instagram influencers around the world (the modern equivalent of the traveling snake oil/magic potion salesman of the frontier days). How about the celery juice diet for a current example?

Fad diets will always be around, as people are always looking for the quick and easy way out (and a way to keep scarfing their pizza and beer every weekend), though the simple fact is they often distract folks from making the best choices and finding a durable nutrition plan for the long haul.

The D-Word Can Be Deceitful, Even Dangerous

A kissing cousin to the distraction issue above is that some diets intentionally mis-state or mis-represent their efficacy, short and longer term impacts, and safety. Approaches like the Five-Bite Diet, the Werewolf Diet, The Baby Food Diet, Beyonce’s Master Cleanse, the Cotton Ball Diet, the Breatharian Diet, among many others, are doomed to fail (for a host of reasons) and have an impressive potential to inflict genuine harm.

The D-Word Leads to Dropouts

Probably the point I’m most concerned about with the cadre of folks that I coach and encourage is this – disruptive, deprivation driven, unsustainable diets ultimately fail; people drop out, get discouraged, assume their goals of improved health and well being are in reality unattainable, and go back to destructive food plans. Yoyo dieting patterns appear to be linked to metabolic and other issues, creating metabolic baggage that will be hard to dump down the road.

One Key Take Home Point: Don’t Diet, Develop a Healthy, Nutritious Food Plan

The take home point here is glaringly obvious, yet takes some thought and effort to work through – don’t diet, you need to develop a healthy, whole foods based, nutritious food plan for yourself (and your family) that fits your tastes, budget, culinary skills, and works for your schedule. Your food plan (or nutrition plan, or whatever you want to call it) must be durable and sustainable over the long haul.

It can be done.

There’s no single “right path” to get there. Your challenge is to listen to your body, educate yourself, and work it out. And interestingly, you’ll likely be tweaking and adjusting your nutrition plan along the way to meet changing life needs and issues that arise.

Foundation Series: Fitness Secret Weapon No. 1 – MOVE

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I had an interesting conversation over the weekend with a good friend from Montana.

He’s a very successful businessman with a loving family; though his principle business interest is commercial (multifamily) real estate, he and his two sons run an impressive grass-fed cattle operation in Montana on three fairly large land plots (they call them ranches up in that part of the world).

We’ve known one another for a lustrum or better now, and he’s been impressed enough with my body composition (and other) changes over the past eighteen months to himself jump on the Primal bandwagon. Working on his seventh decade of a very active life, he’s still out in the field six of seven days per week, though spends the bulk of his time behind a desk. He and his clan have additionally weathered a heart-wrenching tragedy this spring with the loss of a daughter-in-law.

After a rapid and for the most effortless weight loss for the first four months as a Primal guy, he’s been stalled now for the last two months and change. Even more frustrating to him was the fact that he felt his overall fitness level hadn’t changed radically since the New Year. So he called me Saturday afternoon, feeling just a bit defeated, and looking for some answers.

Time for a Bit of Long-Distance Detective Work

The first half hour of our conversation was spent with me mostly listening, prompting with a question here and there, but gradually a consistent story began to take shape, focused around two things.

One, and of lesser importance in the big picture, my friend had been consuming (too much) fruit (mostly South American in origin) on a near daily basis during the long Montana winter, which, pending where you happened to live in the state, persisted via a snowy, cold spring until late April or early May this year. This is another story for another day, but suffice it to say that fructose has been the undoing of many a concerted weight loss attempt.

Two, and perhaps most critically, my compadre hasn’t been moving enough. Yes, he’s busy, some days putting in 15 hours between desk, truck, and tractor, but we pretty quickly came to the same conclusion – he’s been far too sedentary coming out of winter and having dealt with the issues they faced as an extended-family unit this spring.

Back to the Basics with the Secret Weapon of Movement

One of the first things we did together was agree that movement – general, everyday, functional-task linked movement is a critical cornerstone for good health (and the Primal lifestyle). I reminded him that the movement we’re talking about here, the essential, get-off-your-butt and just move stuff, isn’t really what most would call targeted exercise or higher-level training (Sisson speaks to the distinction ably here), but really ought to be something we all think of as an essential, pretty much non-negotiable part of our day.

While for many a goal of 10,000 steps a day is ambitious, my friend noted that much of the tasking that he does “around the place” could be easily accomplished on foot instead of from the seat of a four-wheeler, truck, or tractor. Given the trials of the spring, and a generous spring runoff, he’d not be fly fishing much, though had two excursions involving hiking set up for this week (dang, that sounds like fun).

We chatted about ways to incorporate quick walks into his day, like a quick walk breathing in those glorious summer Montana mornings before settling in for the day’s work, a 10-minute stretch every two hours (or less) during the desk day, a 20-30 minute walk after dinner, and rewarding himself with at least one 2 hour or better hike each week to fish his favorite waters on the Big Hole River near his home.

We agreed that for him, a rational, baseline goal for moving in some form of low level aerobic activity (it works for most of us, too) would be in the 5-7 hours per week range, shooting for at least an hour per day or better (in a addition to his HIIT and resistance workouts he’s been fairly diligent with so far).

Bottom line, moving more is something we all can fairly easily incorporate into our day; it may take a bit of effort and reprograming and old habit or two, but the results build in quickly.

Older Bolder Foundations: Making the Best Fish and Seafood Protein Choices

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We’ve been talking lately about making the best possible choices when shopping for proteins, covering a few principles regarding red meat proteins here and poultry proteins here.

The health benefits of regular seafood consumptions are pretty much indisputable (see here and here for example), with some particular precautions duly noted, and include reduction of chronic inflammation, improved mood and decreased risk of depression, improved cardiovascular and pulmonary health/function, and improved cognitive function across all age groups.

SMASH Your Fish

Two key principles in selecting the best fish choices include selecting fish from colder waters (higher omega-3) and fish lower down the food chain (to minimize concentration of mercury and other contaminants as you move further up the chain).

Remember the SMASH fish five: salmon, mackerel (not king mackerel), anchovies, most sardines, and herring. Smaller fish are most often more economical, and many are canned using quality oils (check to be sure).

Wild-caught fish from remote, pollution free waters should be top on your list (Bristol Bay salmon, we’re thinking about you).

Fish Farms, For the Most Part, Are Not Your Friend

Most farmed fish and shellfish, particularly those raised out of country, are fairly high risk given their exposures to substandard feeds, antibiotic use in pens to address infections caused by compromised water and conditions, are often pesticide-treated given infestations of their tanks, and are often raised in toxic, polluted waters. Many farmed fish and shellfish are even fed artificial coloring agents to tint their flesh more like their wild cousins (common in some Atlantic salmon farms).

There are exceptions to the ‘avoid most farmed fish’ caution, and include domestically raised catfish, barramundi, trout, tanked-farmed coho salmon, crayfish, and most domestically propagated shellfish.

Fish Priorities for Your Plate

Top of the list every time will be the wild-caught, cold-water, oily fish – think the SMASH five; followed by other sustainable, wild-caught fish from pristine waters.

Fish lower on the food chain are your friend for the most part; fish higher on the food chain (i.e. king mackerel, American eel, Chilean sea bass, orange roughy, marlin, shark, swordfish, and some tuna – ahi and big eye) are more prone to bio-accumulation of toxins.

Sustainability of fish stocks has been and will remain a prime concern; for that reason we agree with those who suggest limited consumption of Atlantic cod, halibut, sole, bluefin tuna, and even flounder.

There are several resources available, though the Monterey Bay Aquarium’s Seafood Watch site is probably the most commonly sited resource you need to bookmark and use, and they have a handy pocket guide you can print and carry with you (image cut below).

Fish You’d Never Want to Serve Your Family

Though I was not convinced of this until several years ago, almost all farmed fish from Asia should be avoided given concerns over very lax management of water quality, specifically related to pollution and toxin levels, as well as substandard feeds used.

Another fish to avoid consistently is farmed Atlantic salmon, the species most commonly served by fishmongers and restaurant providers across the country. There’s years of data exposing the travesty of this particular industry, dig around a bit and read more if you’re skeptical.

The Mercury vs. Selenium Debate

We’ve all been cautioned for years about the impressive levels of mercury found in fish stocks, increasing as you move up the food chain, though there’s increasing data available that suggests naturally occurring selenium in fish (high levels except in swordfish and sharks) indeed counteracts many of the concerns regarding mercury in fish. A couple of interesting reads to overview the issue if you’ve not read much on this topic can be found here and here.

Older Bolder Foundations: Making the Best Poultry Protein Choices

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Last week we talked a bit about making the best possible choices for the red meat proteins (wild game, beef, bison, pork, lamb, and goat) you choose to enjoy in your meal rotation.

Today lets cover quickly some key concepts regarding poultry, which for most of us purchasing poultry are talking about chicken and turkey (as opposed to harvesting wild birds – think wild turkeys, ducks, pheasants, geese, quail, and doves for example).

The objective here is to look for and consume pastured poultry (as opposed to CAFO poultry), though it’ll likely take a bit more effort to find than comparable options in the red meat arena.

Pasture-raised birds are so much more tasty and nutritious than their confined (CAFO) kin; folks tend to forget than most fowl are omnivorous, and CAFO operations in essence force feed birds a vegetarian (grain based) diet along with the flood of other unhealthy and in some instances downright offensive supplemental feed products, antibiotics, pesticides, and more.

We’d join the chorus of folks who suggest the very best option is finding a local producer with whom you can verify that birds are truly pasture-raised; they may be feed supplemental grains as well.

Chickens certified as organic by a mass producer are likely indeed fed organic grains but are most often not pastured; their vegetarian diet produces an inferior product compared to pasture-raised birds.

Buy whole chickens (if you never learned to cut one up, check out the video below) and use everything, including the organs, bones (chicken stock is a great thing to keep in the freezer), and render that delicious chicken fat.

Older Bolder Foundations: Making the Best Red Meat Protein Choices

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For those who have (wisely) chosen to consume animal proteins as a tasty and nutritious component of a rational, healthy eating plan, here are a few (fairly concise) thoughts on making the best red meat protein choices possible.

First, Let’s Clear the Deck of a Couple of Red Meat Protein Issues

One, there’s no question that the anthropological data overwhelmingly supports the fact that early man obtained a significant portion (some say up to 85%) of daily calories from animal foods. It’s also fairly clear that among other nutrients, it was protein and omega-3 fatty acid consumption that facilitated the development of the human brain as document in historical records. Despite what may be passionate arguments otherwise, human physiology appears to require animal-derived proteins to optimally develop and function, particularly when considering the simple math of nutrient and caloric density of various foods.

(For those who can’t conceptually separate issues regarding saturated fats from a discussion of red meat proteins, see discussion here on the Fat Paradigm.)

And of note, for many of us, making the best protein choices can’t be done without casting a responsible and thoughtful look at cost issues. A common criticism (and one not necessarily unearned) of popular ancestral eating philosophies (i.e. Primal and Paleo) has to do with the recommendations to eat organic, grass-fed meat.

Choosing these types of meat products, as opposed to the much more widely available CAFO (Concentrated Animal Feeding Operations) meats clearly does most often cost more, though there are fairly simple ways to address meat quality and cost concerns (like cow-pooling, or ordering meat in larger quantities). The principle clearly is to make the best choices you can within your budget.

Just Say No to CAFO

When speaking of proteins, beef cows in particular are grazing animals and are meant to eat various grasses, not grains and other substandard feeds in CAFO operations. In CAFO operations they’re crowded, often in filthy and what some would define as inhumane conditions, and fed grains and other feed products far, far from their historical diet. In addition, cattle (pigs and poultry as well) are often exposed to hormones (to speed growth), antibiotics due to their filthy living conditions, antacids due to the aberrant feed affects on their guts, and pesticides to control pest infestations.

The answer? Fairly simple – find and purchase grass-fed, pasture-raised red meat products. While it’s arguable grass-fed and grain-finished meat has a bit more marbling, it’s best to review with a grower / rancher how they manage split-feeding to ensure animals are primarily pasture fed and not finished with offensive grains or supplemental feeds.

For those with the inclination and access, the best quality red meat available on the planet is probably wild game harvested ethically and managed in a timely and careful way in the field. My son and his wife living in Montana harvest their own game and 90% or more of the red meat protein they consume is wild elk, venison, and bison.

Making the Best Red Meat Protein Choices

So what are the best array of red meat choices available to us today?

As noted above, the very highest tier of red meat quality would be the lean, tasty, omega-3-rich wild game animal ethically harvested and managed well in the field.

In terms of beef, the top choice would be 100% grass fed/pasture-raised stock from a local grower you can interact with personally. Cow-pooling, sharing a full animal or a side of beef is a great way to dip your toe into the water so to speak. Look around, regional cattle operations are a cinch to find on the web these days.

The next tier choice would be certified organic beef, which is often grass-fed and grain-finished, with the next level being conventionally-raised (likely CAFO) beef. IF budget constraints limited grass-fed beef options, limit fat consumption of CAFO animals as many of the toxins introduced in CAFO operations accumulate in fatty tissue.

In terms of pork, wild pigs are growing in popularity, and if you have the means to harvest one, by all means eat all from nose to tail. Pasture-raised pigs are much less common that pastured beef, but if you look around locally odds are you can find some (pig-pooling works too!).

Lamb is another great option, and at this point in time it appears that while American lamb is generally grain-fed during their life cycle, New Zealand and Australian lamb is typically grass-fed and tasty.

And while not common in much of the United States, here in Texas there’s a fair amount of goat meat produced. Goats are interesting in that they’re what a friend calls ‘very opportunistic browsers’, eating brush, weeds, various leaves (even shrubs), and grass. We have several sources of pastured goat available close by, and there’s more and more available online.

Where’s the Beef? (And pork, lamb, and goat)

Finding a local beef (and other red meats) producer aligned with these objectives can become something akin to a treasure hunt; some useful resources to search out local beef, lamb, pork, and goat in your area include:

Grass Fed Guide
Eat Wild
Ranch Meat

Upcoming posts will cover optimal choices for fish and seafood as well as poultry.

Older Bolder Foundations: Unclutter Your Brain and Lower Stress

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One of the most indelible learning moments for me during my medical school years happened during a lecture by a charismatic, stand-up-comedian-level-funny, uber-intelligent and articulate child psychiatrist (whose name unfortunately escapes me as a pen this) as he taught us basic concepts about the neurobiology and neurophysiology of memory.

[He happened to be an enormous man, claiming he weighed “well north of 300 pounds”, had a precocious three year old child he affectionately referred to as “the monster”, and to our loss, was the only African-American lecturer we enjoyed that entire term.]

Your Brain, Short Term Memory, and the Seven Marbles

His premise during this particular series of lectures was that as humans at this stage of historical development, most us of can grasp no more than seven “items” in our active short term memory.

He likened the concept functionally to having a cardboard toilet paper tube positioned between our ears, long enough and of sufficient diameter to hold seven fairly large marbles, each marble representing a nugget of information that is actively stored in our short term memory.

Add another marble (nugget of short term information to remember) into one end, and yet another marble on the other end is pushed from the tube, and unless effectively captured and stored away, just might be lost forever.

He went on to walk us through the fairly complex theories underlying the conversion of short term brain storage to longer term or permanent brain storage, but offered we budding medical students a challenge, a challenge that remains pertinent to this day for just about everyone walking the planet.

The challenge (he riffed on the Mission Impossible theme of “your challenge should you decide to accept it”): continually sort through the huge amount of noise we encounter during a given day or week, pick out the items/nuggets/thoughts/concepts worthy of keeping, and “file” them in either short or long term memory so that we can act upon them intentionally, at the right time, and in the right place.

Far easier said than done; and this was back in the day before email, smart phones (hey, it was the early 80s so there weren’t even any cell phones on hand), PDAs, or really even personal computers.

Chasing Those Marbles and Other Exercises in Futility

As many of you have, I spent parts of the next twenty years utilizing some of the best and most accepted tools of the day chasing those marbles, valiantly trying not to lose any despite what seemed to be an increasingly complex and faster moving world.

I’ve personally been at various times a very devoted list maker, user of various organizers modeled along the classic Day Timer (in fact, there’s one sitting on a nearby office shelf right now), various PDA devices, and (allegedly) smarter phones with bells and whistles designed to make life organization a snap.

As many of you, I’ve found some of these systems to be quite useful but none fully accomplished a critical primary objective – that being a system to capture all those thoughts and ideas, some of which are damned fleeting, popping up and vanishing in a flash, to be dealt with at a later (more expedient or appropriate) time.

Finally, I found that running a very busy spine-focused medical practice and two other family businesses at the same time was simply beginning to overwhelm my abilities to track “all the marbles”, and often those marbles were rattling around in my head at night, interfering with rest and recovery, and occasionally an important marble would fall out, roll away, and be lost forever (or at least until some deadline popped up I’d forgotten about…).

It doesn’t matter what stage of life you’re in, what you do for a living, what your educational background is, or whether you’re a young parent of a growing family (probably the hardest job in the world by the way) or the CEO of a multinational conglomerate – at some point you’ve had too many marbles banging around in your head too.

Collect Those Marbles, Get Them Organized, and Manage Your Stress

Ironically it wasn’t until over 20 years later than two different mentors, at pretty much the same time, introduced me to a concept that has allowed me (along with thousands of others) to collect those marbles, get them more or less organized, and even more importantly, decide which ones need attention now and which can wait until later.

To really work, something like this must have a provision to allow you to capture everything floating around in your head, on your desk (whether you a have a literal or digital inbox), in your email queue, and/or wherever else you happen to have items piling up that need your attention.

There are several approaches out there that provide the structure to accomplish this somewhat tall order, and they’re quite good at getting it done.

My mentors happened to walk me through the concepts espoused by David Allen of Getting Things Done fame; if you’ve not found a structure to use that allows you to clear your head (or desk, or inbox, etc), organize and prioritize the (likely) big list, and then assign a task or action (prioritized of course) to start actually getting done what needs to get done – then give it a look. (One thing I love about GTD is it’s not built around a software program you need to buy, and can be implemented using a wide variety of approaches. I happen to use a very good multi-platform software tool designed by a third party – OmniFocus – but it’s not essential to the process.)

The key point is this: life is busy, and there’s a lot of noise in terms of distractions and demands on your time. If you don’t have the best tools, and (of course) choose to use them, you’ll find yourself distracted, discouraged, unproductive, and unfocused. Collect those marbles, prioritize and sort the actions they demand, and you’ll find yourself energized, sleeping better, and living with more intention and focus.

Your mission, should you decide to accept it, is to find the system that works for you.

More to come, and keep chasing those marbles.