The Obesity "paradox" - Confirmed Once Again

[haidut]

This study looked at people who had undergone cardiac surgery, so it probably does not apply directly to "healthy" people. However, the findings are pretty telling - if you are unhealthy and about to have a surgical procedure being overweight or mildly obese can save your life.

http://jaha.ahajournals.org/content/4/7 ... l.pdf+html

"...Overweight and obese patients had lower mortality and adverse perioperative outcomes after cardiac surgery compared with normal weight, underweight, and morbidly obese patients. The "obesity paradox” was confirmed for overweight and moderately obese patients. This may impact health resource planning, shifting the focus to morbidly obese and underweight patients prior to, during, and after cardiac surgery."

 

[jyb]

How do you interpret that from a Peat perspective? Overweight means you have more fat to use as energy, plus it's likely to be PUFA, and isn't there an association with insulin resistance too? (clogged damaged adipocytes who can't store/release energy properly which means the serum is overflown with both FFA and glucose). I do mean overweight, as opposed to a healthy amount of weight.

 

[Amazoniac]

The distribution of fat should be important too, they used BMI..

 

[haidut]

How do you interpret that from a Peat perspective? Overweight means you have more fat to use as energy, plus it's likely to be PUFA, and isn't there an association with insulin resistance too? (clogged damaged adipocytes who can't store/release energy properly which means the serum is overflown with both FFA and glucose). I do mean overweight, as opposed to a healthy amount of weight.

Barring any dysfunction of the thyroid, low metabolism is likely the result of chronic stress and the consequent elevation of hormones like cortisol, estrogen, prolactin and serotonin. So, in a condition where cortisol, estrogen and serotonin are high a person will put on weight even on very low calorie diet. I think Peat mentioned a study with obese women that kept getting fat even on a 700 calorie daily diet compared to a previous intake of about 2,000. So they got fatter by dieting. Metabolism becomes very thrifty to compensate for what is perceived as times of dearth. Ironically, a stressed person who eats properly will probably get obese BUT will have a higher RMR than a stressed person who stays "normal" weight through "exercise" or calorie restriction. Again - RMR is higher in obese people than in "normal" or skinny people, all other things being equal.
http://baye.com/fat-loss-myths-part-1-o ... etabolism/
http://ajcn.nutrition.org/content/69/6/1117.full
"...Formerly obese subjects had a 3–5% lower mean relative RMR than control subjects; the difference could be explained by a low RMR being more frequent among the formerly obese subjects than among the control subjects. Whether the cause of the low RMR is genetic or acquired, the existence of a low RMR is likely to contribute to the high rate of weight regain in formerly obese persons."

So, I think it is the higher metabolism in a fat person that is responsible for the protective effects seen in these studies. In other words, if you are stressed or sick, then it is much better to be fat than skinny or "normal" weight since it gives the organism some ability to keep RMR higher, lower stress hormones, and recover. That's why being fat should be classified as an endocrine condition and treated as such. In addition to giving thyroid to keep the metabolic rate high I would assess prolactin, estrogen, cortisol, serotonin and treat these as well.
Virtually all human studies testing drugs like aromatase inhibitors, anti-prolactin agents, or anti-serotonin agents for conditions unrelated to obesity (breast cancer, prolactinomas, depression) found loss of fat mass and preservation of muscle mass. It is not coincidental, since all of these agents tend to lower cortisol as well, so effectively they inhibit the stress response, some better than others.
Bottom line - if you are getting fat on a diet that is not grossly hypercaloric or laden with PUFA then your stress hormones are high. To get a quick indication of how high they are - take 500mg of pregnenolone in a single dose. If your wasteline shrinks by an inch or two in a matter or hours then your stress hormones are high and probably need some sort of treatment since I am not sure diet alone can handle it. Most doctors would be able to run tests for cortisol, estrogen, prolactin, and serotonin and prescribe a drug accordingly.
Note: I would not recommend the pregennolone test to people with Cushing syndrome as the results of supplementing pregnenolone are unpredictable in Cushing.

 

[XPlus]

I can relate to that.
I've always carried extra weight on me that I've tried everything to get rid of.
In the prime of my exercise days my pulse was around 50-60bpm (I often had cold hands and feet, too) and I was proud of that.
Once I got into Peating, I started to measure the pulse and temps of everyone around me and surprisingly those overweight and obese who never been athletic have good temperature and pulse ranges according to Peat. Apart from the extra fat, they didn't seem to suffer from troubling health issues (as compared to myself who was very athletic and health conscious).

 

[jaa]

That makes sense haidut. It seems to go hand in hand with stress eating and decision fatigue as well. I know when I'm stressed a small snack high in sugar seems to calm a frenzied body and mind.

 

[Tarmander]

Bottom line - if you are getting fat on a diet that is not grossly hypercaloric or laden with PUFA then your stress hormones are high. To get a quick indication of how high they are - take 500mg of pregnenolone in a single dose. If your wasteline shrinks by an inch or two in a matter or hours then your stress hormones are high and probably need some sort of treatment since I am not sure diet alone can handle it.

This got my attention. Did you have specific treatments in mind? I did not do the 500mg pregn. experiment but one thing I have noticed is sometimes the impossibility of bringing down a stress response even with adequate amounts of sugar and salt. Sometimes it works, sometimes it does not.

 

[haidut]

Bottom line - if you are getting fat on a diet that is not grossly hypercaloric or laden with PUFA then your stress hormones are high. To get a quick indication of how high they are - take 500mg of pregnenolone in a single dose. If your wasteline shrinks by an inch or two in a matter or hours then your stress hormones are high and probably need some sort of treatment since I am not sure diet alone can handle it.

This got my attention. Did you have specific treatments in mind? I did not do the 500mg pregn. experiment but one thing I have noticed is sometimes the impossibility of bringing down a stress response even with adequate amounts of sugar and salt. Sometimes it works, sometimes it does not.

If it is confirmed that cortisol is high, then things that lower it reliably are DHEA, zinc, vitamin A, vitamin B6, Cascara, magnesium, vitamin C, etc.
In addition, zinc, vitamin A and vitamin B6 will also lower estrogen so it is a double benefit.

 

[Tarmander]

Bottom line - if you are getting fat on a diet that is not grossly hypercaloric or laden with PUFA then your stress hormones are high. To get a quick indication of how high they are - take 500mg of pregnenolone in a single dose. If your wasteline shrinks by an inch or two in a matter or hours then your stress hormones are high and probably need some sort of treatment since I am not sure diet alone can handle it.

This got my attention. Did you have specific treatments in mind? I did not do the 500mg pregn. experiment but one thing I have noticed is sometimes the impossibility of bringing down a stress response even with adequate amounts of sugar and salt. Sometimes it works, sometimes it does not.

If it is confirmed that cortisol is high, then things that lower it reliably are DHEA, zinc, vitamin A, vitamin B6, Cascara, magnesium, vitamin C, etc.
In addition, zinc, vitamin A and vitamin B6 will also lower estrogen so it is a double benefit.

Thanks Haidut!