Good (and Short) Taubes Article on Cholesterol

There’s a good article by Gary Taubes (author of Good Calories, Bad Calories) in today’s New York Times (run, I was amused to see, as an Op-Ed), discussing the belatedly-published Vytorin trial results, which touches on one of the issues that he raises in his book, but about which I’ve been too lazy to blog about, as yet — the distinction between low-density lipoproteins (LDL), and the cholesterol carried inside of them.

Though there has been reason to think, for 50 years now, that problems with the LDL lipoproteins themselves were a more important risk factor than the cholesterol they carried, measuring the former wasn’t diagnostically practicable, because of the difficulty and cost, whereas measuring the latter was easy and cheap. In the battle against heart disease, an army of researchers went to war, not with the tools that they might have wanted to have, but with the tools that they had.

In 1977, the researchers reported their results: total cholesterol turned out to be surprisingly useless as a predictor. Researchers involved with the Framingham Heart Study found that in men and women 50 and older, “total cholesterol per se is not a risk factor for coronary heart disease at all.”

The cholesterol in low-density lipoproteins was deemed a “marginal risk factor” for heart disease. Cholesterol in high-density lipoproteins was easily the best determinant of risk, but with the correlation reversed: the higher the amount, the lower the risk of heart disease.

These findings led directly to the notion that low-density lipoproteins carry “bad” cholesterol and high-density lipoproteins carry “good” cholesterol. And then the precise terminology was jettisoned in favor of the common shorthand. The lipoproteins LDL and HDL became “good cholesterol” and “bad cholesterol,” and the lipoprotein transport vehicle was now conflated with its cholesterol cargo. Lost in translation was the evidence that the causal agent in heart disease might be abnormalities in the lipoproteins themselves.

The truth is, we’ve always had reason to question the idea that cholesterol is an agent of disease. Indeed, what the Framingham researchers meant in 1977 when they described LDL cholesterol as a “marginal risk factor” is that a large proportion of people who suffer heart attacks have relatively low LDL cholesterol.

The article is well-written, dense with information, difficult to synopsize (or at least, I’ve found it so), and is, as I’ve already mentioned, short, and worth reading in its entirety.

Read the Full Article in the New York Times
“What’s Cholesterol Got to Do With It?”
by Gary Taubes

Half-Time Show: Forty-Two!

In 1985, I was trim and fit (not to mention 20 years younger). I was walking every night, riding my bike at lunch, and I was down to 179.5 pounds. I am over six feet tall, and that was a good, good weight.

Let us fast-forward to 1999, about 14 years later. Somehow, I had ballooned up to 265.5 pounds!

(Click on the photo to make me even larger)
A (Staggeringly-Fat) Tom Chappell, alongside a Perfectly-Reasonable John Blackburn
Industry Figures Tom Chappell (250 pounds) and John Blackburn, 25 April 2004.

Let’s see, that’s, geez Louise, a gain of 86 pounds. That is not the gain of a pound a year that is so often bruited about in the media; it’s about a 1/2 pound a month. Still not very fast, in the grand scheme of things, as long as you don’t keep it up for 14 years.

Worse yet: ideally, I should really be down to around 165 pounds, a loss of over 100 pounds from my high of 265. That sounds like a ridiculously low weight to virtually every American I’ve mentioned it to, but it gets me down to a BMI of 22, which is about in the middle of the normal range, cuts the diabetes risk like you wouldn’t believe, and might even get rid of the sleep apnea.

And I’m getting there. Here I am, at 207.0 pounds, half-way between my March, 2007 weight of 249 and my goal of 165, and quite a bit more than half-way between my all-time high of 265 and 165:

(You can still make me larger by clicking on this photo, but it won’t be as satisfying)
Tom Chappell and Stephen Newell
Industry Figures Tom Chappell (210 pounds) and Stephen Newell, 29 December 2007

I’ve lost a pound a week, since March, 2007, and I’m going to keep on doing it for as long as I can.

If I can keep it up, then in a little less than a year, I’ll (finally) have arrived at the promised land.

So many people, myself included, have tried and failed to get weight off, or to keep it off once they’ve gotten it off. So far, for me, it seems to be going all right, and it’s worth reviewing: what did I do differently this time? What’s working?

  1. I only try to lose a pound a week. If I get more than a few pounds ahead of the pace, I go out and have something a little wicked, maybe a mini-pizza and a beer, or whatever, which is a nice change of routine. This keeps me from feeling crazy deprived, and just falling completely off the wagon. On the other hand, I really try to hit that target weight every Monday, and actually am happiest when I’m a few pounds ahead of the game.
  2. I limit carbohydrates. This one is unbelievably important. Like practically all overweight people, I’m fairly insulin-resistant, so no other course of action makes sense. I’ve already written extensively, starting here, about why this is absolutely vital, and the totally solid science behind this. Whatever level of carbohydrates you can manage to limit yourself to, the fewer carbohydrates you eat, the leaner you will be.
  3. I check my blood sugar levels. Every morning, I use one of the glucose test kits sold in drug stores to see where the previous day’s rampages have left my blood sugar levels. You can’t lose weight if insulin levels are high, and high blood sugar levels mean high insulin levels, so lower is better (up to a point, of course). I used to cruise at about 105, solidly pre-diabetic, but for the past 5 straight weeks, I’ve averaged 92, which is great, and this week I’ve been averaging an 86, in the fabled Smug Bastard range. I also use them to check to see what an unfamiliar meal does to my blood sugar levels.
  4. I don’t particularly limit dietary fat or protein. I don’t suffer from gout, so I don’t have problems from eating too much muscle flesh. And I haven’t seen a lot of compelling evidence that higher dietary fat dramatically increases all-cause mortality, though I stay away from trans fats. These foods help slow down the carbohydrate rush, keep me from feeling starved, and keep my metabolism revved up.
  5. I exercise a lot more. Exercise is said to reduce insulin resistance, reduces blood glucose levels, helps keep HDL levels high, and blood pressure low. You can lose weight without a lot of exercise, but exercise provides a broad range of benefits, so I exercise.

    Furthermore, a recent study found (University article, journal abstract) that exercising for longer periods is more helpful for reversing the Metabolic Syndrome than is exercising more vigorously for shorter periods, so a great deal of my exercise is just walking around.

    My general routine is two 40-minute fast-paced walks per day (one at lunch, and one later in the day), and 40 minutes of cardio workout after work (alternating at 80% and 60% of my maximum heart rate), every day. Yep, two hours a day. And that’s not even counting the 50-mile bike rides that I often do on the weekends, which themselves are training rides for the 100-mile one-day century rides that I do once or twice a year, mostly for the bragging rights.

    I didn’t start out at that level; I built up to it. I currently shoot for 1,000 calories of exercise per day, though my median in the last nine months of 2007 was 744 calories/day.

    My New Year’s resolution was to increase my amount of strength training (hence the personal trainer), which will probably cut into the existing routine somewhat.

    Note that the bulk of my exercise is in 40-minute chunks, which gives me time to get warmed up and then still do a noticeable amount of exercise, doesn’t require me to bring along special food for the exercise, and doesn’t leave me craving a snack after the exercise. I’ve also had good results going for a walk after dinner, which gives me something to do away from the refrigerator and helps cut down those post-prandial blood glucose levels.

  6. I exercise with a buddy. My carpool partner, Industry Figure Larry Helmerich, is right at my side for almost all of my workouts. We have a small gym at work, a fantastic benefit, and it’s just routine for us to stop and work out at the end of the day, before driving home. And then my long weekend bicycle rides are with some combination of fellow Alcatel-Lucent cyclists Ron, Carlos, and Vincent. It’s easier, and more fun, with a buddy.
  7. No food is actually forbidden, in moderation. If I find myself feeling resentful about not being able to have a food, I make a point of having a small portion of it right then, because constant, unrelenting deprivation makes you crazy. I don’t eat out often, but if I am eating out with my friends or family at, for example, Romano’s Macaroni Grill, where they have amazing bread, I go ahead and have a little, especially if I’ve got a few pounds in the bank. I usually limit it to 1/4 of one of their loaves, rather than the whole loaf or so that I used to eat, and dip each mouthful in the olive oil that they provide, hoping that the olive oil will slow down the carbohydrate uptake from the bread.
  8. I brown-bag lunch, or have a small lunch at the cafeteria at work, 4 times a week. This makes lunch so fast that I have time to do one of my 40-minute walks after eating, which gets some exercise in, and helps to lower my blood glucose level after the meal. But then once a week we go out for lunch, which is a nice treat.
  9. I eat more fruits and vegetables (though not starchy vegetables like potatoes). They’re filled with micronutrients, give my stomach something to think about, and if nothing else, lengthen the meal a bit to give my body enough time to realize that it’s full. And nowadays, you can almost always get restaurants to give you some broccoli or asparagus instead of mashed potatoes.
  10. At home, I cook most of my own meals. Growing up, we basically never ate out — it was all healthy meals, prepared at home, rather than crazy meals like a double burger, fries, and a milkshake. Making your own meals gives you a lot more control over what, and how much, you eat.
  11. At home, I use slightly-smaller plates and bowls. Just about an inch smaller in diameter, which translates into 20% smaller surface area, and arguably more like 25% less usable space. There are a million little ways in which your brain can be fooled into just accidentally eating a little more, or a little less, and I try to set up the things that make me accidentally eat a little less.
  12. I get a good night’s sleep. As I mentioned recently, getting too little sleep has been shown to dramatically worsen insulin resistance.
  13. I drink coffee, tea, and wine “moderately”. Coffee drinkers have, as a group, a lower risk of Type 2 diabetes than non-drinkers. At least one mechanism explaining why this should be so has been identified, and successfully tested, too. (Coffee inhibits the enzyme 11β-hydroxysteroid dehydrogenase type 1 from re-activating the stress hormone cortisol from existing serum cortisone, if you want to know.) The important ingredient isn’t the caffeine, either, so go ahead and have decaf, if you prefer that. Of course, I’m not sure how many doctors would call my 2 to 4 mugs of coffee a day “moderate”, but I call it that, so at least someone does.

    I also drink 2 to 3 cups of tea (which has its own advocates), and drink fractionally more than three 5-ounce glasses of wine a day. (American doctors don’t call that “moderate” wine drinking, but British and French doctors do. French doctors even say that men can have 5 glasses of wine a day, bless them.) What everyone agrees on, though, is that some drinking is better for your health than no drinking or a lot of drinking; you’ve got to draw the line somewhere.

  14. I obsessively track my progress. This one wasn’t here until Stephen posted his comment, but I’d actually thought of it while driving home tonight, too. Absolutely! I measure all sorts of things, pretty much daily: weight, BMI, fasting blood glucose, morning b/p, evening b/p, number of glasses of wine per day, calories spent exercising per day. And then weekly, I measure my waistline. I’ve got graphs that I could show you, because I’m a monomaniac! Eh, it’s working for me.

    Seriously, though, measuring your waistline is fantastically important, because muscle weighs more than fat, and when you start exercising, or even right in the middle of your diet, you might find that you’re gaining weight, or not losing it, but your waistline is shrinking every week.

    If that happens, cut yourself a break, even if it goes on for weeks or months — you’re trading body fat for muscle. Eventually you’ll start losing weight again.

Forty-Two Pounds To Go. Easy!

Oh, Ow…Why? (New Personal Trainer)

I’ve written before about the cardinal rule of being instructed by a physical therapist or personal trainer, and it’s this: people are naturally efficient, and they are particularly good at exercising the muscles that they normally use, and at not exercising the muscles that they don’t normally use. So, when a trainer tells you how to do an exercise, what usually happens is the first time or two you do it, you think, “Hey, this one’s going to be easier than the others!” And then, they tell you that you should bring your elbows in, or twist your hands a little differently, or go this way, and then…no, see, this one’s hard, too.

My trainer was very solicitous, always asking if the weight seemed right, usually wanting to adjust it until I could answer that it felt like a good medium weight, though occasionally she would bump it up a bit. And through most of the ordeal, I felt like, “This is going pretty well, yeah, I feel exercised!”

Monday’s session was all about the upper body: chest, shoulders, and arms. Afterwards, she had me hold out my arms straight ahead of me, and would laugh girlishly in an amused/alarmed manner at how much my arms were shaking, and then show me another stretch to do to loosen them up, or direct me to do one that she’d already shown me, but nevertheless, here I am, a few hours later, a beaten man.

Oh, and I signed up for another 16 sessions. At twice a week, that’ll take me through to Solvang, in early March.

“Ha ha, ohmygod, your arms are still really shaking! Ok, let’s do another stretch.”

National Body Challenge – Free 8-Week Fitness Club Pass

Discovery Health is doing something called the National Body Challenge, which includes a variety of features, such as exercise plans and what look like some tasty recipes.

It’s free, and if you sign up (really) soon, you can download an 8-week free pass to your local Bally Total Fitness, as well as a free personal trainer session, which alone is about a $50 value.

Now, Bally’s doesn’t have the best reputation in fitness clubs, but the one I went to smelled better than the local 24-Hour Fitness, had decent equipment, and was properly air conditioned.

They didn’t ask me to sign anything other than an injury waiver, didn’t ask for my credit card number, didn’t pressure me to sign up for a paid membership. Seems to be a straightforward free trial.

I fell in love with the Life Fitness elliptical cross-trainers there. They easily get my heart rate up to the cardio target rate, and then just vary their resistance to fit my pace and keep my heart rate at that target. Lots of machines have similar settings, but this one seems particularly well-suited for charging along in time to the music on my iPod.

I’m scheduled to take my free personal trainer session tomorrow. I’ll report back.

Read about the National Body Challenge.

Sign up for the National Body Challenge.
Then be sure to download your free 8-week pass ASAP, because that offer expires soon.

Industry Figures Descend On Indianapolis (5 Missing, Presumed Dead)

My old college buddies, Industry Figures Leah and Stephen Newell, drove 3 hours from Illinois out to see me while I was visiting my mother and my sister’s family near Indianapolis, and they wouldn’t even let me buy them lunch.

We had the best visit ever, and the time just flew by: as we were pulling out of the restaurant parking lot, I called Stephen on his cell phone:
    “Man, that was 3 1/2 hours, just now!”
    “I know, I was just doing the math!”

Click on the picture to see the whole horrible affair. And be sure to follow the link on that page to see us all 28 years ago, too.
Tom Chappell and Stephen Newell
Industry Figures Tom Chappell and Stephen Newell