Body Mass Index Under Scrutiny

In yesterday’s post "The Obesity-Disease Connection" The New York Times explained how obesity can make ovarian cancer even more dangerous and harder to survive. Nicholas Bakalar reported:
But among patients with Stage III or Stage IV disease, the most advanced stages, those with B.M.I.’s greater than 25 survived disease free for an average of 17 months, compared with 25 months for people with indexes lower than 25.
For each increase of one unit in the index, the researchers found a 4 percent increase in the risk of recurrence and a 5 percent increase in the risk of death.
In Eat to Live you’ll see Dr. Fuhrman agrees; obesity increases a person’s risk of a whole host of medical conditions:
  • Increased overall premature mortality
  • Adult onset diabetes
  • Hypertension
  • Degenerative arthritis
  • Coronary artery disease
  • Cancer
  • Lipid disorders
  • Obstructive sleep apnea
  • Gallstones
  • Fatty infiltration of the liver
  • Restrictive lung disease
  • Gastrointestinal disease
Alright, so we know being obese doesn’t help your chances of living a long healthy life, but what about this whole BMI thing? As reported by The New York Times the whole ovarian cancer study was based on these measurements. But is it really the be-all-end-all for determining if someone is obese, or even if they’re just overweight?


Linda Carroll of MSNBC reports some health experts definitely concerns about the Body Mass Index:
The real question, says Dr. Donald Cutlip, an associate professor of medicine at the Harvard Medical School, is whether body mass index is a good measure to determine whether someone is overweight.


The conflicting studies, each based on BMI scores, point out flaws with the common measure, basically a comparison of height to weight.

New research shows that there’s a better, more informative way to figure out if you are overweight—the waist-to-hip ratio—and all it requires is a measuring tape.
A lot of the worry stems from the BMI’s inability to give an accurate measurement for elderly people or individuals with a lot of muscle:
Cutlip agrees that BMI can be way off, especially when it comes to assessing a particular individual. The commonly used measure can give a skewed result not only for fit body builders who come out with a high number because of the extra weight associated with muscle, but also for the elderly, who tend to have scores that underestimate obesity because they have so much less muscle.
A more favorable way of determining if someone has dangerous levels of body fat might be the Waist-To-Hip Ratio. Carroll explains:
The best way to predict heart attack risk and other obesity-related diseases is a measurement that divides the circumference of your waist by your hips.


If you’re a woman, the waist-to-hip ratio should come out as no more than 0.8. Men have a little more wiggle room: a healthy waist-to-hip ratio for them is 0.95.

This means, if your belly has bulged out enough to catch up to the size of your hips, you should start worrying about your heart, experts say.
(Be sure to try out the calculator accompanying the article.)


Now considering all this, how does Dr. Fuhrman determine if a person has an unhealthy bodyweight? The answer is right between his fingers:
I just take a pinch near the umbilicus and squeeze it lightly between two fingers and measure the distance between the fingers.
In a previous post he talks about his method: A Life Plan for The New Year
Most people lose weight and then stop losing when they have reached their ideal weight. You are not the judge of your ideal weight; your body is. As almost everyone is overweight, many people think they are too thin when they have reached their best weight. I have many patients who, after following my plan to reverse diabetes or heart disease, report, “Everyone tells me I look too thin now.” I then measure their periumbilical fat and check their percentage of body fat, and usually show them they are still not thin enough.

The Obesity-Disease Connection

In the opening pages of Eat to Live Dr. Fuhrman makes a point that is often overlooked by the average American dieter:
Obesity is not just a cosmetic issue—extra weight leads to an earlier death, as many studies confirm.1 Overweight individuals are more likely to die from all causes, including heart disease and cancer.
Much of Dr. Fuhrman’s work strives to show people the strong correlation between diet and disease. You know the old adage, you are what you eat. Being overweight doesn’t just mean your favorite outfit is a little snug, it means you’re putting yourself at an increased risk of premature death. More from Eat to Live:
Two-thirds of those with weight problems also have hypertension, diabetes, heart disease, or another obesity related condition.2 It is a major cause of early mortality in the United States.3
Health Complications of Obesity
  • Increased overall premature mortality
  • Adult onset diabetes
  • Hypertension
  • Degenerative arthritis
  • Coronary artery disease
  • Cancer
  • Lipid disorders
  • Obstructive sleep apnea
  • Gallstones
  • Fatty infiltration of the liver
  • Restrictive lung disease
  • Gastrointestinal disease
Considering all this, this recent report from The New York Times shouldn’t be all that surprising. New research reveals being obese can make ovarian cancer even deadlier and harder to survive. Nicholas Bakalar explains:
It is well known that obesity is associated with various malignancies, including kidney, throat, breast and colon cancers. Findings about obesity and ovarian cancer have been somewhat less clear, the researchers say, but evidence from previous studies suggests that obesity predicts a worse outcome for ovarian cancer patients as well.


The scientists wanted to know whether excess fat, apart from any other health problems it might cause, had direct effects on tumor growth. They reviewed the medical records of 216 patients at Cedars-Sinai who had surgery for epithelial ovarian cancer. The data included information on height, weight, age and any other diseases. The cause of death was presumed to be cancer related if the patient had advanced recurrent disease at the time of death.

Half the patients had ideal weight, with a body mass index from 18.5 to 24.9, and 8 percent had a B.M.I. of less than 18.5, considered underweight. Twenty-six percent were overweight, with indexes exceeding 25, and 16 percent were obese, with indexes higher than 30.

The overweight and obese differed little from normal and underweight people in age or in health status, except that they had more hypertension and diabetes.

But among patients with Stage III or Stage IV disease, the most advanced stages, those with B.M.I.’s greater than 25 survived disease free for an average of 17 months, compared with 25 months for people with indexes lower than 25.

For each increase of one unit in the index, the researchers found a 4 percent increase in the risk of recurrence and a 5 percent increase in the risk of death.

This “dose response” effect strongly suggests that obesity alone is responsible for the decreased survival time, Dr. Li said.
The results of this research are pretty jarring. It seems like being obese is like dragging around an old refrigerator; it slows you down, makes you uncomfortable, creates its own problems along the way, and makes many other problems worse. Time to ditch the fridge!


Or more importantly what’s in it. Dr. Fuhrman will tell you the typical American diet rich in processed foods, saturated fats, refined sugar, and salt is a one way ticket to obesity, disease, and early death. Back to Eat to Live:
As long as you are eating fatty foods and refined carbohydrates, it is impossible to lose weight healthfully. In fact, this vicious combination of a sedentary lifestyle and eating typical “American” food (high-fat, low-fiber) is the primary reason we have such an incredibly overweight population.
On the other hand he believes the secret to healthy bodyweight, disease prevention, and increased longevity is just the opposite; a plant-based diet comprised of fruits, vegetables, legumes, nuts, and seeds:
There is no longer any question about the importance of fruits and vegetables in our diet. The greater the quantity and assortment of fruits and vegetables consumed, the lower the incidence of heart attacks, strokes, and cancer.4
Continue Reading...

Marathon Runners: A Poor Diet Can Slow You Down

Jim Hage of The Washington Post tells the story of marathon runner Casey Smith who, despite some early success, is currently out of racing and on the mend. Why? She found out the hard way that her sudden, dramatic weight-loss wasn’t as healthy as it seemed:
Shortly thereafter, Smith began to lose weight. "This shouldn't be happening," she told herself. But in the world of elite racing, particularly for women, fast times are often a function of body weight, and racers tread a fine line between competition and self-destruction. By the spring, Smith had shed 15 pounds from her 5-foot, 100-pound frame. At the St. Patrick's Day 10K, Smith dropped out of a race for the first time.

"At first, I was worried," said Smith, 27. "But then, I said I'm feeling good, my workouts were good, and I started running pretty well again. It's hard to describe what was happening. Lots of runners watch what they eat."
She decided to do something about it:
Smith began to work with a nutritionist and sought professional assistance. She didn't regain the lost weight, but she realized she had a problem and resolved to adopt "a healthy attitude."

"Eating disorders, that's crazy," she says now. "How does that ever happen? But keeping the weight off becomes a subconscious thing; you don't want to put it back on. It's like an addiction."
The issue of athletes not fueling their body with nutrient-rich longevity-promoting food is nothing new to DiseaseProof. Check out Dr. Fuhrman’s critique of Detroit Pistons star Richard Hamilton’s diet.

Weighing Food and Trying to Eat Smaller Portions is Futile

From Dr. Fuhrman's book Eat to Live:

It is meaningless to compare foods by weight or portion size. Let me provide and example why this is the case. Take one teaspoon of melted butter, which gets 100 percent of its calories from fat. If I take that teaspoon of butter and mix it in a glass of hot water, I can now say that it is 98 percent-fat-free, by weight. One hundred percent of its calories are still from fat. It didn’t matter how much water or weight was added, did it?

In fact, if a food’s weight were important, it would be easy to lose weight, we would just have to drink more water. The water would trigger the weight receptors in the digestive tract and our appetite would diminish. Unfortunately, this is not the way our body’s appestat—the brain center in the hypothalamus that controls food intake—is controlled. As I’ve explained in the past, bulk calories and nutrient fulfillment, not the weight of the food, turn off our appestat. Since the foods Americans consume are so calorie-rich, we have all been trying to diet by eating small portions of low-nutrient foods. We not only have to suffer hunger but also wind up with perverted cravings because we are nutrient-deficient to boot.

We must consume a certain level of calories daily to feel satisfied. So now I ask you to completely rethink what you consider a typical portion size. To achieve superior health and a permanently thin physique, you should eat large portions of green foods. When considering any green plant food, remember to make the portion size huge by conventional standards. Eating large portions of these super-healthy foods is the key to your success.

Calories: More Than Meets The Eye

Charles Stuart Platkin of The Seattle Times examines the claim many distressed dieters make, “I hardly eat anything, but I can’t lose weight!” Is there any truth in this? Dr. Fuhrman would likely contend if you’ve reached this impasse you’re probably eating the wrong foods and following a poorly constructed diet plan, but let’s see what Platkin turned up:
It's been reported in the New England Journal of Medicine that people attempting to lose weight tend to underestimate the amount they eat by as much as 47 percent and to overestimate their physical activity by as much as 51 percent. When scientists at the USDA's Beltsville Human Nutrition Research Center in Maryland asked 98 men and women how much they ate in a 24-hour period, they found that 6 out of 7 women underreported by an average of 621 calories, and 6 out of 10 men underreported by an average of 581 calories.

When the American Cancer Institute did a study asking Americans to determine the portion sizes of eight specific foods, only 1 percent got them all right. Sixty-one percent couldn't get more than four correct.
So, clearly many dieters have good intentions, but limited or poor knowledge of nutrition (specifically that of certain foods) sabotages their weight-loss goals. Imagine if people knew better! Consider this excerpt from Dr. Fuhrman’s book Eat to Live:
Green vegetables are so incredibly low in calories and rich in nutrients and fiber that the more you eat of them, the more weight you will lose. One of my secrets of nutritional excellence and superior healing is the one pound-one pound rule. That is, try to eat at least one pound of raw green vegetables a day and one pound of cooked/steamed or frozen green vegetables a day as well. One pound raw and one pound cooked—keep this goal in mind as you design and eat every meal. This may be too ambitious a goal for some of us to reach, but by working toward it, you will ensure the dietary balance and results you want. The more greens you eat, the more weight you will lose. The high volume of greens not only will be your secret to a thin waistline but will simultaneously protect you against life threatening illnesses.
This previous post has more: Foods That Make You Thin

In order to test caloric misconception Platkin pits a number of popular snack foods against each other. For example, did you know a Pringles potato chip actually has more calories than a McDonalds French fry? It’s true! Check it out:
One Pringles potato chip vs. one McDonald's french fry

Believe it or not, one french fry has only five calories, while a single Pringle is double at 10 calories.

One bite-size cube of cheddar cheese vs. one Famous Amos Chocolate Chip Cookie


Clearly the cheese is the better choice nutritionally, but cheese is not a health food you can consume without guilt — one bite-size (1/2") cube has 55 calories, whereas the cookie has only 37.5. Whenever possible, go with low-fat cheese. A great one is Cabot's Vermont 50% Light Cheddar — 35 calories per 1/2" cube.

One Fritos Original Corn Chip vs. one cashew nut


Here again, the cashew has health benefits that far outweigh those of the nutritionally bland corn chip; however, cashews have 8.5 calories per nut, whereas Fritos have five per chip. So just because nuts are healthful doesn't give you carte blanche to overindulge — you're supposed to eat nuts in place of something else in your diet that's high in calories and nutritionally inferior, not simply add them.

Nutrient Dense Foods Are Key

According to new research low-calorie dieting can allow you to eat more food and ingest less calories. Now, if you read Eat to Live you already know this to be true. The key is to consume large amounts of healthy nutrient-rich plant matter which fills you up, but doesn’t burden you with excess calories. The Reuters report seems to agree:
Using dietary information from 7,500 U.S. adults, researchers found that those who reported eating plenty of fruits, vegetables, fiber-rich grains and other lower-calorie foods typically ate a larger amount of food than their peers who favored richer fare.

Yet they ate several hundred fewer calories a day, while consuming more calcium, iron, potassium and vitamins A, C, B6 and folate.
It all boils down to those fiber-full fruits and veggies:
In general, foods that have a high amount of water and/or fiber, such as fruits and vegetables, also have a low calorie density. Water and fiber add to a food's bulk, but contribute few or no calories.

Sugar, fat and flour, on the other hand, pack on the calories, and calorie-dense foods include chips and other snack foods, nuts, sweets and processed or fatty meats.

So while study participants who filled their diets with low-cal fare ate more food by weight, they ingested fewer calories — an average of 425 fewer among men, and 250 fewer among women.

Dr. Fuhrman's Five-Day Super-Diet Challenge

You’ve heard about so-called “miracle cleansing” and detox diets, now you can give your body a real cleanse with high-quality foods.

You’ll be amazed at what Mother Nature can do with real food and no magic formulas. The Five-Day Super-Diet Challenge is completely different from the all-too-common fake “bowel cleansing” and “liver detox” programs you’ve heard about-programs that are little more than typical alternative-medicine scams.

Mother Nature’s Cleanse

The most important thing to understand about detoxification is that it is an ongoing bodily process. It isn’t something you can buy in a package. The healthier you are, the easier it is for your body to keep its tissues clean.

In order to maintain excellent health and true internal cleanliness, you must avoid all harmful, irritating substances (such as salt, pepper, and hot spices) and eat a diet rich in phytochemicals and antioxidants. Fresh fruits and vegetables contain the most powerful healing agents. They nourish your body and help maximize its normal functions. The only way to effectively detoxify is to live and eat healthfully, and allow your body to do its thing at full throttle.

At the end of this article are delicious recipes that you can use to jump start your diet and detox program and lose weight at the same time. Let’s see how you feel after five days of eating Nature’s most powerful healing foods. Follow my cleansing diet for five days (or more) and send your results to me. I want to know how good you feel and how much weight you lose!

Toxic, Irritating Laxatives
Why am I so opposed to the “detox in a box” programs that have become so popular? The most important reason is they don’t work. Besides that, they also are harmful.

No special pills, powders, or herbs can detoxify you. The “health food” and supplement manufacturers combine a mix of herbal laxatives—such as senna and cascara—with some walnut hull, and they claim that these bowel irritants will detoxify you. Laxatives can no more detoxify you than washing your mouth out with soap can.

A false claim commonly made in “natural” laxative advertising is that you have years of hardened mucus and food stuck like glue on the wall on your colon. Well, guess what? You don’t, and thousands of sigmoidoscopies and colonoscopies done by me and other physicians prove it.

When you eat a nutritious, high fiber diet, the walls of your intestines and colon will be pristine. Long-term exposure to the right amount and balance of natural fibers and natural food containing nutrients is the only way to protect your bowel and your body against disease.

Another problem with laxatives is that they are habit-forming. The more you stimulate your bowels by irritating the nerves lining your gut, the less reactive your bowel will become to the normal nerve stimulation from food. Before too long, you will be dependent on laxatives for normal bowel movements.

You can’t transform a toxic substance into a healthful one by asking your marketing department to give it a catchy name like “Ultimate Cleanse” or “Super Detox Cleanser.” Below are two examples of popular, but toxic, bowel-irritating formulas (and the claims made for them), sold on the internet and in health food stores.

Bowel Clear—Each tablet contains: cascara cagrada 500mg, golden seal 150mg, black walnut 350mg, rhubarb 200mg, elecampane 100mg, wormwood 100mg, sage 500mg, rice bran 800mg, soya bran 667mg.
The label claims that these ingredients “work like an Intestinal Broom; scrubbing & sweeping the inner walls of your colon, allowing larger amounts of unwanted waste matter to pass easily & regularly through your bowel.”
Ultimate Cleanse—Each tablet contains: psyllium seed, aloe vera powder, senna leaf, cascara sagrada, barberry root, rhubarb, slippery elm bark, cayenne 40,000 H.U.
The label claims that this product features “29 powerful cleansing herbs that stimulate the cleansing and release of toxins and poisons trapped in the body from poor dietary habits and environmental pollutants.”
Detoxification is an ongoing process in a healthy body. No substance can pull toxins out of the body. The body can utilize nutrients to fuel its normal processes, and it acts to keep itself clean when given the chance. Your body does all the work.

Toxic substances stimulate; healthful substances nourish. Simulation is a form of irritation; it ages you. Avoiding stimulation is an important component of a health-building program.

Detoxify Naturally
Follow my Five-Day Super-Diet Challenge and you will be amazed at what happens! Use the recipes below periodically and enjoy a genuine internal cleanse. You will lose weight and feel better—and you might decide to change your diet forever.

Dr. Fuhrman’s Five-Day Diet-Cleanse Recipes

Breakfast
Fruit Plate
One whole grapefruit or two oranges
One box of blueberries
One box of strawberries
Lettuce (optional)

Arrange on a plate and serve.
Lunch
Blended Salad
8 oz. baby greens
One orange
Juice of ¼ lemon

Blend in a blender and serve.

Healthy Slaw
½ cup shredded raw cabbage
½ cup shredded raw beets
½ cup shredded raw carrots
1 cup shredded apple
¼ cup raisins

Toss together and serve.
Dinner
Spinach Salad
4-6 oz. baby raw spinach
¼ finely shredded red onion
2 Tbsp. unhulled sesame seeds
1 Tbsp. ground flax seeds
1 Tbsp. sunflower seeds
1 box (pint) blackberries
2 Tbsp. pear or fig vinegar, if desired

The Green Machine
4-8 oz. raw chopped kale
4-8 oz. raw chopped bok choy
4-8 oz. chopped broccoli rab
2 large tomatoes, chopped
4 cloves garlic, chopped
2 cups chopped mushrooms
One medium onion, chopped

Add tomato, garlic, onion, and mushrooms to pan. Cover and simmer on low heat for 5 minutes. Add greens on top and continue to cook in covered pan on low heat for 5 more minutes.

Apple-Stuffed Peppers
One red pepper
One medium apple
½ tsp. cinnamon
Pinch of nutmeg

Chop apple. Mix with cinnamon and nutmeg. Cut top off of pepper and remove core and seeds. Stuff pepper with apple mixture and bake in oven at 400 degrees for 15 minutes.