The Role of Inflammation in Body Weight: An Intro to the Biology of Fat

Inflammation comes up a lot in my practice. It promotes many chronic diseases and correlates with worsening signs and symptoms of many conditions, whether it be autoimmune disease, arthritis, cardiovascular disease, or others. Inflammation is also intrinsically tied to obesity.  How are inflammation and body weight related and what can we do about it?

What is inflammation?

Inflammation is your body’s attempt to protect itself. It involves complex biological processes that are activated by things like foreign invaders (bacteria and viruses for example) or damaged cells (injury). We need inflammation to protect ourselves from these harmful stimuli and to initiate healing, but we want this inflammation to resolve. When it doesn’t, or there is always a stimulus promoting inflammation, we get chronic inflammation. Chronic inflammation is associated with chronic diseases like autoimmune disease, atherosclerosis, cancer, HIV/AIDS, allergies, and has even been connected to the pathophysiology of depression.  Chronic inflammation can lead to and exacerbate cardiovascular disease, insulin resistance, and a host of other problems. It is also an important feature of obesity.

The Many Roles of Fat 

Our fat cells are more than just energy storage. They are a vital part of the endocrine system. We NEED our fat cells (adipocytes) to help regulate insulin sensitivity, for sex hormone production, to insure a functioning immune system, and regulate metabolism through hormones associated with the fat cells themselves (adiponectin and leptin are the most studied, resistin is another).Adiposity

Adiponectin

Adiponectin is an important metabolism hormone, enhancing insulin sensitivity of skeletal muscle and the liver, helping clear glucose from the blood stream. Adiponectin decreases as body weight increases resulting in increased insulin resistance with weight gain. (1) There are genetic reasons for low adiponectin levels as well that are known to increase the risk of type 2 diabetes. (2)

Adiponectin ties in to inflammation in part with vascular disease. Adiponectin inhibits a cell signaling protein involved in inflammation called TNF-α and affects plaque formation in the arteries. It does this by inhibiting the conversion of immune cells called macrophages to foam cells which are implicated in plaque buildup in the arteries. (3) In general, higher adiponectin levels are associated with lower body weight, better blood sugar control, and reduced inflammation, particularly in blood vessels.

Raising Adiponectin Levels

Your adiponectin levels are in part regulated by genetics but there are things you actually can do to raise adiponectin levels. Eating a diet high in fiber, getting plenty of omega-3s, exercise, and weight loss have all been shown to raise adiponectin levels. (4)

Leptin

Leptin is another hormone secreted by fat cells and is most known for suppressing hunger signals, but it has many other interesting effects as well. These include influences on the immune system, metabolism, bone and blood vessel formation, and reproduction.

Leptin levels directly correlate with the amount of energy stored in the adipose tissue. In obesity more leptin is secreted because there is more adipose tissue. Based on this you might expect heavier people to have less hunger, but we know this isn’t true. The reason obese people still have strong hunger signals is because there is a mechanism at play reducing the sensitivity of cells to leptin’s actions so its impacts on satiety are blunted.

High Leptin –> Elevated Immune Response –> Elevated Inflammation

The elevated level of circulating leptin in obesity contributes to low-grade chronic inflammation by upregulating inflammatory cytokines (like TNF, IL-12, and IL-6). Leptin levels also increase when there is other inflammatory stimulus, further increasing inflammation, (5) and has many other effects on both major immune system branches known as adaptive and innate immunity. Leptin’s influence on the immune response is also apparent when there are low levels, which leads to an impaired immune system—not producing an inflammatory response when you do want it. (6)

Elevated leptin levels and the associated elevation in inflammation are almost always associated with an elevated BMI.

What can we do to improve leptin sensitivity?

When weight is lost and leptin levels decline hunger signals increase. This is one of the reasons sustained weight loss is challenging, so finding ways to improve leptin sensitivity may improve outcomes of weight loss attempts.

  • Improve triglyceride levels. Triglycerides are fats that are often associated with heart disease. They are a standard part of your cholesterol blood work. Having high triglycerides can induce leptin resistance. (7) Things that can help lower triglycerides include weight loss, exercise, a low carbohydrate diet, reducing alcohol consumption, and not smoking.
  • Because leptin is associated with a feeling of fullness, doing other things to help you feel full like eating protein and healthy fats with each meal or snack can help create a more sustained blood sugar and curb hunger.
  • Reduce total body inflammation because inflammation signals to the brain appear to be an important factor in leptin resistance. (8) I’ll discuss more on this later.

Resistin

Resistin is another adipose-derived hormone that appears to have a strong role in the pathogenesis of cardiovascular disease, type 2 diabetes, and inflammation. It is actually primarily secreted by macrophages but is also secreted by fat cells and is associated with the inflammation associated with fat. It promotes endothelial cell dysfunction (the cells lining blood vessels and lymphatic), increasing multiple pro-inflammatory mediators.

Reducing resistin

  • Antioxidants – Studies have shown resistin can be reduced by consuming antioxidants like vitamin C, which you can get from your diet from eating fruits and vegetables.(9)
  • Optimize Folate Levels – Folate has been shown to improve not only endothelial cell dysfunction, but also reduce homocysteine (which, when elevated is associated with atherosclerosis), as well as reduce resistin itself.(10)
  • Olive oil may also be beneficial. Oleic acid, the primary fat in olive oil, was shown to reduce DNA expression of the resistin gene in fat cells.(11)

Macrophage Phenotypes

The following paragraphs get pretty science-y, so buckle up, or skip it.

A macrophage is an immune cell that I like to picture as Pac-Man, gobbling up inflammatory debris. For those of you paying attention, you may be saying, “Wait! Didn’t you say macrophages release resistin and can promote inflammation?!” Yes. They play a very interesting role in inflammation and obesity, being beneficial in some cases and inflammation-inducing in others.

I will explain (with the caveat that this is a bit of an over-simplification):

Macrophages come in 2 major types, M1 and M2 (with subsets of the M2 form), and they do different things. M1 is thought of as pro-inflammatory while M2 is associated with anti-inflammatory reactions. (12) Obesity pushes the balance to be M1-predominant resulting in more inflammation. (13)

What do you do to improve macrophage phenotype to M2?

More recently discovered compounds called resolvins, which are constituents of omega-3s, show promise as a potential therapy because they recruit macrophages. Not only that, resolvins and its precursor, DHA, actually promote the M2 phenotype which suppresses Th2 inflammation and fibrosis. (14) (15)

Researchers have indeed proposed that resolvins may be a potential treatment for obesity-associated inflammation but more research is necessary to determine the extent of its therapeutic application. In phase 2 clinical trials side effects have not been documented. Caution should be used however because macrophages do accumulate in obesity, especially with lymphatic impairment because a functioning lymphatic system is necessary to move these immune cells away from the periphery so they don’t accumulate and potentially cause damage. There may still be benefit due to the changes to an M2 phenotype as mentioned above, but it is still best if a healthcare provider determines if this may be an appropriate treatment on an individual basis.

Higher adiponectin can also promote M2 macrophages, so see above for ways to improve adiponectin levels.

Decreasing Total Body Inflammation

Because so many chronic conditions are caused or exacerbated my inflammation, trying to decrease chronic inflammation is important.

One way to reduce inflammation associated with obesity probably goes without saying—lose weight and inflammation will likely decline. (16) In the meantime there are other things you can do as well.

Fat cells themselves aren’t the only source of inflammation in the body and because inflammation can contribute to so many different chronic conditions, identifying other causes of inflammation and correcting this excessive immune response is important.

  • Eliminate or greatly reduce added sugar – Sugar is ubiquitous in the standard American diet. Some obvious like soda, baked goods, and candy, but some less obvious like added sugars in yogurt, pasta, crackers, and sauces.  For many cutting sugar can be incredibly challenging. I find eliminating all added sugars for 14 days is rather effective at reducing or eliminating sugar cravings in many people. For others it is better to identify personal obstacles and individualize a plan to decrease sugar consumption. The American Heart Association and the American Diabetes Association recommend limiting added sugars to below 25 grams daily
  • Address allergies – This includes identifying food allergies and sensitivities and removing them from the diet either through an elimination/re-challenge diet or testing, as well as addressing environmental allergies.
  • Eat plants – Plants contain many different compounds such as polyphenols that help reduce oxidative damage in the body. Eating a rainbow of colors can help you get many different types of these phytonutrients.Phytonutrients
  • Other dietary strategies – Choose a diet that is right for you that also has anti-inflammatory benefits. The Mediterranean diet is generally a good dietary strategy for most people and has been shown to have numerous benefits on cardiovascular risk markers such as inflammation. It has even been shown to change the way DNA is expressed of several inflammation-related genes. (17)  It is characterized by healthy fats like those from olive oil, nuts and seeds, poultry, eggs, seafood, whole grains, and lots of colorful fruits and vegetables.  Some people may benefit from other diets such as the ketogenic/high fat low carb diet or certain dietary strategies such as intermittent fasting (limited eating window) for example. Consult your healthcare provider to help determine the diet that is right for you
  • Stress reduction – The “stress hormone” cortisol causes increased inflammation after acute stressors, whether it be a vicious animal chasing you or sitting in traffic. It does this to get your body’s immune system prepared to repair or defend.  In modern society we tend to have many low-grade stressors (i.e. getting the kids to the bus stop on time, that presentation you have to give, paying bills, etc) resulting in a lot of signals to increase inflammation. Meditation, breathing techniques, and even intermittent fasting can improve your response to stress
  • Optimize Sleep – Your sleep is very important for proper immune system function and getting poor sleep, especially over a long period of time is another chronic stressor. Also included would be addressing sleep apnea, a condition where the person’s breathing is interrupted many times throughout the night.Sleep Optimization
  • Supplements – Supplements should be individualized to each person to maximize the benefit. There are multiple botanicals that appear to have anti-inflammatory effects, in some cases supplementation of high quality omega-3 fatty acids is beneficial, and the previously mentioned resolvins also have potential. Since sources of inflammation can vary greatly I recommend seeing a provider, such as a naturopathic physician, who is well-informed about supplement quality, herb-nutrient-drug interactions, and evidence-based use of these formulas.

Support the Lymphatic and Vascular Systems

The lymphatic system is an immune network and waste removal system. When inflammation is present we need our lymphatic system to clear inflammatory debris. In conditions like lymphedema or late stage lipedema with lymphatic involvement, this system isn’t working properly and fluid builds up in tissues, including inflammatory proteins and immune cells like macrophages.

  • Again, eat plenty of phytonutrients – Phytonutrients have a vast array of beneficial actions on the body. Proanthocyanidins are primarily found in berries. These and other compounds can help rebalance connective tissue turnover in venous walls (i.e. matrix metalloproteinases vs. tissue-building enzymes), help reduce inflammation, and even positively affect DNA expression. Proanthocyanidins and tannins have been shown to be beneficial in chronic venous insufficiency and lymphatic insufficiency.(18)
  • Skin Brushing – Skin brushing or dry brushing is a technique that reportedly helps aid lymphatic flow. It is done by using a dry, natural fiber brush and gently brushing your body surface in the direction of lymphatic flow.Exercise
  • Exercise – Both the increase in blood flow and the muscle contractions helping pump lymphatics are 2 of the many benefits exercise can provide for the lymphatic system. Whether it’s walking, swimming, or jumping on a trampoline, being active is vital for vascular and lymphatic health.
  • Other lymphatic and vascular support options like medications and supplements should be personalized to you to address things like cardiovascular disease or lymphedema for example.

Disclaimer: This article is intended only to inform, not to diagnose or treat. Please see your healthcare provider for evaluation of any health concerns.

Continue reading “The Role of Inflammation in Body Weight: An Intro to the Biology of Fat”

Tried & True Ways to Stick to Your Health & Fitness Goals

We’ve all been there. You set a goal for yourself… to quit smoking, to lose weight, to be stronger, to eat healthier… but you lose track. You maybe don’t even know when you veered off course, but you find yourself no longer following the plan.

Right around February 1st the gyms are already thinned out as the New Year’s resolutions become less resolute. A few weeks after a month long strict dietary regimen the bad habits are back.

Don’t blame yourself. This time, do something different.

Here are some goal setting and achieving strategies that have worked for many of my patients to help create sustainable lifestyle changes and I’m confident that by implementing some of these strategies you will have better outcomes too. So get out a pen and a paper (seriously) and let’s start working on setting you up for success.Tried & True Ways to Stick to Your Health & Fitness Goals

Individualize Your Plan

Your friend or your co-worker may have things that work very well for them, but don’t be surprised if their plan doesn’t work for you. You have your own obstacles that you need to overcome and the first step is to identify them.

Below I will walk through the top 5 obstacles I see in my practice as well as techniques to help deal with them.

  1. Not Enough Energy – This is number 1 for a reason. It is one of the most common symptoms I hear about and the most common reason for patients not getting to the gym or cooking healthy meals. Fatigue can be a symptom of many things, so if you do not know why you’re tired, you should be evaluated by a healthcare provider. If you are tired because you aren’t sleeping enough, this should also be addressed. Other techniques that can be helpful include:
    • Going to the gym in the morning rather than after work or whatever else you fill your day with. It will make the rest of your day go better too.
    • Going at times you are more rested like on the weekends or earlier in the week.
  2.  Not Enough Time – Prioritize your health. If you do not have your health you will not be able to give yourself to your other priorities. Your health is an investment and part of what you have to give is time. If you feel you don’t have time to exercise or to cook healthy meals now, ask yourself: “How will this change? Where will I make more time?”
    • Schedule it in your calendar at times that will actually work.
    • Plan shorter workouts. You don’t need to spend an hour in the gym to get a good workout in. Aim for 20 minutes even.
    • Make it a goal to never miss more than 2 days in a row at the gym. Keep a calendar on your fridge where you write in what you’ve done so you can easily keep track.
    • If it is nutrition-related, master a few simple cooking techniques that don’t require planning (or if you’re a good cook, remember it’s okay to keep things super simple sometimes!) Sautéing or steaming vegetables, pan-roasting fish, making a good omelet, and baking chicken or just a few simple techniques that make it easy to throw together a quick and healthy meal.
  3. Money – This is more personal, but your health is an investment. Gym costs vary widely and many people can find fairly affordable gyms nearby. If paying for a membership is truly not an option there are many exercises you can do at home. Eating healthy doesn’t have to be expensive either, but you also need to take into account the longer term costs of eating unhealthy.
  4. Loss of Motivation – This largely comes down to goal-setting and ways to keep you focused. Below I’ll walk you through an evidence-backed way to formulate your goals to set you up for success.
  5. Old Habits Interfere With New Habits – These old habits could be anything from snoozing the alarm, habitual smoke breaks, to sugar cravings and snacking. There are 2 major ways to help address this obstacle: If/Then and Repeal & Replace.
    • If/Then – Address your obstacles before you get to them by using the “If/Then” technique. For example, “If I come home and start rummaging through the pantry and the fridge, then instead I will make a cup of tea.” This is a similar technique to one used in psychology where you use negativity as a trigger to do or think something positive.
    • Repeal & Replace – If you take something you enjoy away from yourself, replace it with a healthier option you also enjoy. The above example can also apply here, but another example would be to replace a candy bar/pastry with a square of dark chocolate.
    • Understand that some of these habits may be in your DNA. There is increasing evidence that certain genes may contribute to behaviors such as snacking, sweet tooth, and eating disinhibition for example. By identifying the obstacles you can still overcome these habits, it just may be harder for you than for some other people.Tried & True Ways to Stick to Your Health & Fitness Goals

 Set SMART goals

  • Specific – Be specific. When I give my patients a treatment plan it needs to be specific or they are not as likely to stick to the plan. I wouldn’t tell someone: “Your vitamin D is low. Start taking vitamin D,” and leave it at that. You wouldn’t know what to do! If I say: “Start taking 2,000 IU vitamin D3 daily for 3 months” you now know exactly what to do. The same goes for exercise and nutrition plans.
  • Measurable – Rather than saying “my goal is to run more,” set something measurable like, “my goal is to run a 5K.”
  • Attainable – Your goals should be realistic. Don’t set a goal that is not really that attainable, like losing 10 lbs by next week. A more realistic goal might be losing 6 pounds in 4 weeks for example.
  • Relevant – You may need to reach a little deeper to make your goals relevant to you. What really resonates about your goal? For example, is it really about just losing weight? Or do you want your clothes to fit more comfortably or want to be more active with your kids?
  • Time-specific – When do you want to achieve your goals by? If you want to run a 5K, why not plan to do it by May?

Have you been tweaking your own goals to fit the SMART goal technique? If not, give yourself 5 minutes to do that now.

If you haven’t realized this already, you definitely want to WRITE YOUR GOALS DOWN!

Tried & True Ways to Stick to Your Health & Fitness Goals

The Timeline

You also want to set up your SMART goals for long-term and shorter term:

Long-term – Why are you doing this at all? What ultimately do you want out of this? Examples could include bench pressing your body weight, running at 10k, reducing body fat %.

Mid-term – 4-6 months out is a good time frame to think about. It’s on the horizon but you’ll have to put in some work to get to this goal. Examples could be running a 5k, lifting a % of your body weight, or doing a certain number of push-ups.

Short-term – 3-4 weeks is a pretty reasonable short-term goal time frame. If you can do zero push-ups now, maybe do 6 in 4 weeks. If you aren’t running at all now, maybe in a month you could be running 3 miles.

Very short-term – This would be your goal for the next workout or the next day. This could be doing one more rep in an exercise, running another 0.1 or 0.25 miles, or eating another serving of vegetables.

Goals can be small. Be kind to yourself and don’t beat yourself up if you don’t achieve them. The little bit more you do next time is more than you’ve done before.

Seeing Results

When you aren’t seeing the results you are hoping for it can be incredibly frustrating, especially when you are putting in the work. You certainly want to make sure there isn’t something wrong preventing you from seeing results (nutrient timing, metabolic abnormalities, weight-lifting form, etc). I also find it highly beneficial to re-frame and keep track of results in different ways. Examples:

  • % muscle mass
  • % body fat
  • waist circumference
  • number of reps/sets
  • weight lifted
  • body mass index
  • how you feel

Many trainers and gyms (and our office) have body composition testing that can tell you your body fat percentage and muscle mass. I find these much more valuable than pounds on a scale. Additionally, you can gain strength while not necessarily gaining much muscle mass, so keeping track of different results can help you see the results and keep you engaged.

Re-Group

Plan to re-group and re-assess your goals and your techniques for overcoming obstacles. If something isn’t working, be honest with yourself and develop a new way to make it work better for you.

Using the 1st of the month as a planned date to do this works for a lot of people because it feels like a new beginning.

Accountability

Studies have shown that having a partner whois pursuing similar goals can help you keep to your goals. This could be a gym buddy, significant other, or friend you regularly check in with. If it just doesn’t work with other people’s schedules or you are more likely to be pursuing it on your own, consider a trainer, signing up for classes, or simply telling someone else about your goals.Tried & True Ways to Stick to Your Health & Fitness Goals

Now can be the time that you stick to your goals and make a sustainable plan that works for you. If you have trouble identifying some of your obstacles some healthcare providers, like myself, would be happy to help. If one of your obstacles is fatigue, make sure there isn’t an underlying condition causing it that should be addressed. I recommend bookmarking this page and reviewing it during your 1st of the month check-ins to keep you on a good course.

Getting the Most out of Weight Lifting: An Introduction to Protein, BCAAs, and Nutrient Timing for Optimizing Athletic Performance

 

This article was originally published at Whole Health Associates’ website

By Aylah Clark, ND

The exercise supplement industry is thriving as the popularity of weight lifting in particular has increased. I love that weight-lifting is becoming more popular, especially among women, but there is a lot of misinformation out there. This doesn’t mean you should avoid exercise supplements completely however because some do have a lot of evidence behind them.

Although getting nutrients from food is ideal, sometimes supplementation around exercise can actually be very helpful in optimizing the right nutrients at the right time. If you are supplementing are they working for you? Are you taking the right ones? Are you taking enough or even at the right time?Weight Lifting

Foundationally, the right diet with appropriate proportions of macronutrients (protein, fats, carbs) in the form of healthful foods, adequate sleep and recovery, and good exercise techniques are essential. As we get those ducks in a row, we can also move toward optimizing specific nutrients and their timing which I focus on here. Continue reading “Getting the Most out of Weight Lifting: An Introduction to Protein, BCAAs, and Nutrient Timing for Optimizing Athletic Performance”