Stress, the Immune System, and the Microbiome

As we discussed yesterday, it seems likely that our interior bugs are, in a very real sense, “the boss of us.” Even when this idea was relatively novel, a article by John F. Cryan and Timothy G. Dinan outlined the hopes that appeared on the horizon for treating eating disorders and obesity by way of the gut-brain axis.

From the start, connections with stress response were identified. At the time, they wrote:

Accumulating data now indicate that the gut microbiota also communicates with the CNS — possibly through neural, endocrine and immune pathways — and thereby influences brain function and behavior.

Dr. Emeran Mayer, who has been investigating the human microbiome for 35 years, says:

The hypothesis that microorganisms in our intestine have somehow managed to hack into our reward system, enabling them to make us crave for foods that are good for them, is intriguing. If this concept turns out to be correct, one could speculate that as a by-product of this food-seeking strategy, alterations in mood may be a consequence…

Credentialed as both gastroenterologist and neuroscientist, Dr. Mayer directs UCLA’s Oppenheimer Family Center for the Neurobiology of Stress. Via the Center’s Ingestive Behaviors and Obesity Program, he seeks to learn whether, and how, the gut microbiome affects eating behavior in obesity and weight loss. Important questions need to be asked about hedonic value and the effects of hyperpalatable foods.

The Center team studies the impact of stress as expressed through sex, race and culture, and the possibility that brain structure plays a role. Brain-gut interaction is suspected of taking a major part in three particular areas: autism, chronic pain and obesity. Dr. Mayer says:

The question driving our research is: why do overweight people continue obesogenic behaviors even though they deconstruct their lives on multiple levels?[…] 1.4 billion people are overweight. Are all of those brains broken?

In this worldview, the role of family genetics is recognized but occupies a backseat. Also acknowledged is the tendency of bariatric surgery to cause appetite reduction and changes in food preferences. One of the Center’s openly proclaimed goals is to reproduce those brain changes without surgical intervention.

The researchers collaborate with UCLA pediatricians to study food preferences, eating habits and behavior, and brain activity in children. Then, there is what Dr. Mayer calls the chicken and egg question: “Do abnormalities in the gut influence the brain, or do abnormalities in the brain influence the gut?”

Two things are for sure. Microbes and their metabolites send out signals, and our bodies are riddled with receptors where those signals land. In the gut, they activate vagus nerve endings which are compared to an information highway to the brain.

This particularly disturbing quotation concerns stress hormones:

Animal studies have shown that the release of these chemicals can change the gene expression profile of the bacteria in the gut, causing their virulence genes to be up-regulated.

In other words, when the adrenal glands secrete adrenaline, and nerve fibers release norepinephrine, some gut bacteria are stimulated to become more infective and pathogenic. When the chemicals hit the receptors the micro-organisms develop superpowers that enable them to inhibit or evade the person’s immune response and make all sorts of other aggressive moves.

By one estimate, two-thirds of the human immune system resides in the gut. As we have seen, certain bacteria prefer a substance that we can’t ourselves digest, and turn resistant starch into butyrate, which feeds our T cells, which reinforce the gut lining and strengthen the immune system.

Other bacteria are not so cooperative. What if some of the feelings we interpret as stress and anxiety are caused by the tension of the inner battle between our intelligent consciousness, which wants to do what is best for us, and the constant nagging of trillions of organisms that have some contrary agenda in mind?

Your responses and feedback are welcome!

Source: “Mind-altering microorganisms: the impact of the gut microbiota on brain and behaviour,”, October 2012
Source: “A Hijacked Brain and a Tongue Held Hostage,”, 08/07/14
Source: “From the Desk of Emeran A. Mayer, MD,”, Spring 2014
Source: “Why we feel emotions in our guts, and what microbes have to do with it,”, 07/08/16
Source: “9 Weird Things Killing Your Gut,”, 04/08/14
Photo credit: gianky via Visualhunt/CC BY

The Mental-Emotional Dots

Over the past few years researchers have zealously pursued knowledge about the microbiome. Many tantalizing clues tie our inner populations of bacteria and other creatures to all sorts of possibilities for avoiding and curing serious medical conditions including obesity and its many co-morbidities. As a picture is constructed, bit by bit, from seemingly unrelated discoveries, the situation is compared to a connect-the-dots game.

Why do people compulsively overeat? How does it compensate for the sorrows and disappointments of life? Is binge eating a behavioral addiction? How much of our behavior is actually dictated by the demands of the trillions of organisms that live inside us? When we order a pizza delivery at 11 PM, is it really the bugs who coerce us to pick up the phone?

Addiction is so complicated because it isn’t just physical. It isn’t only mental, either, or solely emotional. The constituent members of the microbiome resemble addiction, in that they don’t just operate on the physical plane, either. Gastrointestinal bacteria release metabolites into the blood that communicate with the nervous system, and a lot of evidence points to their ability to mess with our heads.

Microbiome studies challenge our preconceptions. Efforts to interpret their evidence take us to the edge of credulity. The microbiota seem able to influence both thought processes and emotions. Critters who can do that need to have a wary eye kept on them. They influence stress-related behaviors, and when they are out of balance and in disarray, they urge us to make bad decisions. The famous gastronome Jean Anthelme Brillat-Savarin wrote:

Digestion, of all the bodily functions, is the one which exercises the greatest influence on the mental state of an individual. says the inhabitants of the GI tract

[…] can activate neural pathways and central nervous system signaling systems. Ongoing and future animal and clinical studies aimed at understanding the microbiota-gut-brain axis may provide novel approaches for prevention and treatment of mental illness, including anxiety and depression.

Billi Gordon, Ph.D., puts it like this:

If the signaling of informational substances is compromised in the body, the brain is affected. So, in summation, your mind is the sum of the wisdom of your neuropeptides, and other informational substances, under the advisement of your gut-bacteria.

Dr. Gordon indirectly (and probably unintentionally) points the finger of impending doom at a group with no cause for joy about advances in microbiome knowledge — the surgeons who operate on stomachs. Conversely, he mentions Dr. Emeran Myer, who “is looking at changes in the tummy bacteria in bariatric populations that could one day replace bariatric surgery with nutritional intervention.”

While it is true that a morbidly obese person might have psychological and emotional problems, maybe the cause and effect relationship is not what we have been assuming. Maybe when the bugs are in order, with the right proportions of the right species, the obesity is taken care of, and the related psychological and emotional problems melt away.

Your responses and feedback are welcome!

Source: “Gut–brain axis: how the microbiome influences anxiety and depression,”, 2013
Source: “Your Mind Does Not Care What Your Brain Thinks,”, 03/10/14
Photo credit: Thomas Quine via Visualhunt/CC BY

Mood, Happiness, Obesity, and Resistant Starch

An awful lot of obesity is attributable to emotional eating, whether performed in binge mode, or slowly and steadily. The habit of stuffing down emotions by inserting food into the mouth seems to qualify as a bona fide behavioral addiction.

Evidence mounts, pointing to the gut microbiome as an entity that influences emotions and behavior. When the wrong populations of bacteria get out of control they can stir up depression and anxiety disorders. What is going on down there?

Many connections have been observed between behavioral changes, and the beneficial metabolites generated by bacteria who feed on resistant starches. Fitness expert Mark Sisson suggests that resistant starch can be thought of as a special type of prebiotic which, even though we ourselves don’t digest it by enzymatic breakdown, nourishes the microbiota and benefits us indirectly.

Transported through the small intestine into the colon, resistant starch is welcomed by the resident bugs that metabolize it into short chain fatty acids like butyrate. explains the details:

The cells that consume butyrate are T reg or T cells. T cells provide a barrier of defense against pathogens and help strengthen the immune system. In addition to these claims, T cell regeneration is expected to lower the risk of colon cancer, the 4th most common form of cancer to cause death internationally. Any abundance of butyrate, up to a certain point, that isn’t consumed by the T cells moves into the bloodstream and benefits insulin levels and liver function.

One effect of consuming resistant starch is reduced intestinal permeability, which indirectly prevents obesity. Why? Because the inelegantly named “leaky gut syndrome” aggravates such auto-immune diseases as rheumatoid arthritis and multiple sclerosis. People who suffer from these chronic illnesses are unhappy, and often seek to improve their moods by comfort eating. A less permeable gut lining alleviates these painful auto-immune conditions, which increases happiness, and lessens the likelihood of comfort eating.

Beneficial microbes at work

Researchers have shown in the laboratory that resistant starch increases satiety — which generally leads to decreased eating. They also harbor a strong suspicion that giving the microbiota resistant starch promotes the production of the mood stabilizer serotonin, soothing anxiety and alleviating the symptoms of stress. It also appears to boost the production of melatonin, with various beneficial effects.

The American Psychological Association, which knows something about mental health, says…

[…] gut bacteria produce an array of neurochemicals that the brain uses for the regulation of physiological and mental processes, including memory, learning and mood. In fact, 95% of the body’s supply of serotonin is produced by gut bacteria…

Resistant starch does not accomplish these desirable results alone, but through acting in concert with other prebiotics, including fish oil, which reduces inflammation and promotes the growth of bacteria that produce butyrate and other short chained fatty acids.

Your responses and feedback are welcome!

Source: “The Definitive Guide to Resistant Starch,”, 03/26/14
Source: “Resistant starch: Healthy or Not?,”, undated
Source: “The gut microbiome: how does it affect our health?,” MedicalNewsToday, 03/11/15
Source: “Fish oil may be important to altering the microbiome, reducing anxiety,”, 10/06/15
Photo via Visualhunt

Early Inklings of the Gut-Brain Axis

Actually, what is being discussed here is more accurately called the microbiome-gut-brain axis, because what goes on in the digestive tract is pretty much determined by the bacteria and other organisms that live there.

It has long been known that anxiety, stress, and other negative emotions can mess up the orderly processes carried on in the intestines. Recently, it has become more and more apparent that the gut affects higher cerebral operations and mood and behavior. When people are emotionally distressed and not thinking straight, they make a lot of bad decisions that affect health and especially weight.

How could microscopic creatures, even massed in trillions as they are in our gastrointestinal tracts, possibly impact our mental and emotional health? It strains credulity to imagine that various populations of bugs team up to influence our thinking and our actions, but the evidence keeps piling up.

Neuroscientist Dr. John Cryan found some of the earliest indications that signals from bacteria could penetrate the supposedly well-protected brain. In 2011 he published a paper suggesting that…

[…] micro-organisms in the gut tickle a sensory nerve ending in the fingerlike protrusion lining the intestine and carry that electrical impulse up the vagus nerve and into the deep-brain structures thought to be responsible for elemental emotions like anxiety.

At the Texas Tech University Health Sciences Center, Dr. Mark Lyte has been exploring psychoneuroimmunology for more than 30 years. Today, it is widely accepted that stress can suppress the immune system, but back then it was a crazy idea. By the early 1990s, he was pretty sure that stress affects the bacteria that cause infection, and designed lab experiments to prove it.

But was this a two-way street? Could bacteria also induce stress in people?

As usual, figuring this out involved rodents. Stress-inducing ordeals were designed for them, to which they reacted with more anxiety if infected with Campylobacter jejuni. Other scientists had already shown that antibiotics caused mice to be less cautious, which implied that they experienced less anxiety than their untreated compatriots. Related work went on elsewhere, described here by Peter Andrey Smith:

Sven Pettersson, a microbiologist at the Karolinska Institute in Stockholm, published a landmark paper in Proceedings of the National Academy of Science that showed that mice raised without microbes spent far more time running around outside than healthy mice in a control group; without the microbes, the mice showed less apparent anxiety and were more daring.

When the human body is deficient in the amino acid GABA, anxiety is often experienced. This inhibitory neurotransmitter has a calming effect on nervous activity. Xanax, Valium and other anti-anxiety drugs seem to work by targeting GABA receptors in the brain. In nature, immense quantities of GABA are exuded by the bacterium Lactobacillus rhamnosus.

Dr. Cryan and his team from Ireland’s University College Cork collaborated with other scientists from Ontario’s McMaster University on a classic study of “behavioral despair” that became known as “one of the best-known experiments linking bacteria in the gut to the brain.” In what was called the forced-swim test, the curious people in white coats stressed a bunch of mice by letting them believe they would drown. But if the mice were fed a broth containing Lactobacillus rhamnosus, they were much more relaxed, acting in fact as if they were on Prozac.

This probiotic (good or helpful) bacterium is used to create yogurt. Pregnant mice who are stressed tend to pass less Lactobacillus rhamnosus to their babies. Human infants pick up the bacterium while passing through the mother’s birth canal, a fact connected to observations that babies delivered by Caesarean section are more likely than naturally birthed children to become obese.

Somehow, this all fits together and spells out the message that attention paid to the microbiome will not be wasted, and will in fact turn out to be very useful in the battle against obesity.

Your responses and feedback are welcome!

Source: “Can the Bacteria in Your Gut Explain Your Mood?”, 06/23/15
Photo credit: IsaacMao via Visualhunt/CC BY

Tracking the United Kingdom

This post continues to follow the progress of efforts to end child obesity in the United Kingdom. Previously, we saw that suggestions included making local laws about the number and placement of fast food establishments, or “takeaway outlets,” and creating a branch of the military to confront obesity as if it were another type of natural disaster, or even a terrorist attack.

Early in 2015, it was reported that one in 10 U.K. children started school obese at age four. By the time they got out of primary school, one in five (twice as many) were rated obese.

Unsurprisingly, children from the economically deprived stratum of society were in the worst trouble. It was news like this that stirred up motivation coach Steve Miller, who urged the country to initiate “Warn a friend they’re fat day,” and went on to suggest that parents of obese children should receive three warnings and then be incarcerated for a term of two years, or (the more merciful alternative) have their children taken away to be raised by someone else.

Around the same time, Sarah Boseley reported in The Guardian that poor diet accounted for as many as 70,000 deaths annually in the United Kingdom, costing the National Health Service (NHS) as much as six billion pounds (close to $8 billion USD) each year. The British Medical Association urged restrictions on takeaway outlets, and stronger efforts to get good food to school children and to keep bad food away from them.

Britain had been rubbing along for years with the soft-drink industry’s voluntary action, self-policing, blah blah blah, and a lot of people were sick of it, realizing that they and their kids were sick from it. The Royal College of Physicians issued a statement from its president, Professor Jane Dacre:

Although it is the NHS that is responsible for helping individual patients with the consequences of poor diets, the way to prevent this happening in the first place is to take action across the complex pattern of our lives — our environment, our transport, our leisure activities, our shopping and eating habits, and our education. Every government department should be not just passively aware of these issues, but actively producing policies to support the reduction in obesity and health harms.

The Scientific Advisory Committee on Nutrition warned the Queen’s subjects that they should cut their sugar intake by half, at least. The British Medical Association thought this would be an opportune time to call loudly for a 20% tax on sugar-sweetened beverages, which would pay for fruit and vegetable subsidies to benefit the poor.

The Department of Health (DOH) replied that the government was not considering such a measure. A total of 140,000 people signed a petition supporting the sugar tax.

Malcolm Clark, speaking on behalf of the Children’s Food Campaign, said:

It seems absurd that the Government is prematurely ruling out a potent part of its arsenal for reducing excessive sugar consumption. If the Government is serious about tackling childhood obesity and diet-related ill health, then a sugary drinks duty must be one of the options that are on the table for consideration.

Still, the DOH nixed the soft drink tax notion.

Your responses and feedback are welcome!

Source: “Childhood obesity: Number of overweight kids doubles by end of primary school years,”, 03/03/15
Source: “Doctors demand a 20% tax on sugary drinks to fight UK obesity epidemic,”, 07/12/15
Source: “British Government Rules Out Tax on Sugary Drinks, Despite 100,000-Strong Petition,”, 09/23/15
Photo credit: Nana B. Agyei via Visualhunt/CC BY

That Month Comes Around Again

Yesterday, we looked at some responses to Child Obesity Awareness Month from the standpoint of basic factors that don’t seem to be widely addressed. The suspicion that obese kids are not being listened to is upheld when considering the public relations literature from the journal Childhood Obesity.

It seems that the roots of underlying problems are not being reached. A letter to its supporters notes that the publication is read in 170 countries and that its impact factor is 2.543.

We also learn that the content includes “the latest state-of-the-art meta-analytic, systematic, and narrative reviews, randomized clinical trials, innovative empirical reports, and other key childhood obesity issues articles.”

Yet somehow, the trend toward obesity remains in full swing, and it begins to seem as if nobody has come much closer to a definitive answer that will stop that epidemic in its tracks. This may be a hasty conclusion, but a glance at the article titles from several issues reveals no hint that overeating might be a behavioral addiction, or that children might be reacting to the intentionally engineered habit-forming qualities of modern processed foods.

Why is Childhood Obesity News not making a bigger deal out of National Child Obesity Awareness Month? Well, around here, that’s every month. But for anyone who feels that more of an observance is called for, here is a compendium of appropriate and always timely posts from the archive. (To avoid repetition, the month’s name is abbreviated.)

Pokemon Go Update

It’s not just that people walk around in search of imaginary critters. Players can buy eggs that acquire the power to hatch when enough footsteps are accumulated. A newly added feature allows steps in the physical world to accrue credit to buy candy for the imaginary beings.

Some journalists have been rather rude, suggesting, for instance, that the game inspires more healthy activity in a week that the White House has inspired in years. David Bartosiak said:

If this came out 8 years ago, the First Lady would have eradicated childhood obesity.

Apparently, many Americans delight in the opportunity to throw shade on the First Lady. Wisconsin writer Andrew Dawson interviewed 22-year-old gamer David Abbott, who said:

This game has done more to combat childhood obesity than anything Michelle Obama has ever done.

Coming at it from a Libertarian perspective, Michigan’s John C. Mosena opined that the cartoon animals “motivated by profit for their developers” are more effective in getting kids off the couch than any of Mrs. Obama’s efforts. He reported that, in July, an estimated 21 million users of of all ages were playing the game for at least half an hour a day. (At the end of August, the estimated number of daily players was 30 million.) Mosena regards this as a reminder of the limits inherent in the “top-down government approach to social problems.”

Meanwhile, let’s hope that no one is rude enough to suggest that Pokeman Go has done more to prevent overweight than either Childhood Obesity News or the American Academy of Pediatrics!

Your responses and feedback are welcome!

Source: “Childhood Obesity,”, undated
Source: “The Old Guys Guide to Pokemon Go,”, 07/12/16
Source: “Imaginary Pokemon causing some real world issues,”, 07/13/16
Source: “Imaginary Murder Pets Versus Michelle Obama,”, 07/15/16
Image by Saad Akhtar

Some Possibly Missing Pieces

September is National Child Obesity Awareness Month, which the American Academy of Pediatrics chose to observe by offering a 20% discount on selected products. To make a long story short, it’s what Dr. Pretlow describes as the “same ol’, same ol’ type of products — energy balance, nutrition, physical activity, 5210…”

Among the available merch is the 5210 decision support chart, which helpfully includes the insurance codes for health services applicable to obesity and related comorbidities. PediaLink covers an online learning course in pediatric obesity prevention. Pediatric Obesity is a textbook for primary care physicians. Next Steps is about followup care. Five books, including an e-book, are about nutrition.

As Dr. Pretlow has mentioned many times, his experience has shown that people are just about fed up with nutrition information. By now, most American parents and school-age children have a pretty good grasp of the idea that raw apples are better than french fries. What parents need more are techniques to preclude tantrums in the supermarket aisles, the sneaking of unhealthful snacks at friends’ houses, and the general circumvention of standards the parents attempt to uphold.

When it comes to kids who are old enough to act independently, what they desperately need are ways to live day-to-day life while resisting the inexorable pull of cravings for ubiquitous junk food. Instead, what they get is “Energy In Energy Out,” a brochure with an on-the-nose title. In between correct eating and physical activity, balance is said to be found. This and four other brochures are available in packs of 50 for distribution to the parents of patients.

So what?

What seems to be missing here is awareness of psychologically-rooted truths. For instance, many parents have absorbed harmful customs handed down through generations of misguided parenting. One of those bad parenting habits is using edible treats as an incentive, a reward, or even a bribe. When any manifestation of pain or unhappiness causes a cookie to magically appear, no amount of nutritional information can compensate for the harm done.

The American patient pool draws from many ethnicities and cultures, whose collective identities embrace the notion that a fat kid is a healthy kid, along with an ingrained certainty that the best and most effective way to demonstrate love to a family member is to shove delicacies into her or his mouth. This age-old problem is unlikely to be solved by a brochure.

Children overeat to cancel out bad feelings. Even in the most enlightened and nurturing families problems exist. Kids overeat to drown sadness, anxiety, their own perceived inadequacy, and a thousand other unpleasant feelings. In the event that home life is optimal or close to it, school can be the breeding ground for multiple varieties of stress.

But even when health professionals acknowledge that deep forces are at work, the road to recovery is unlikely to be accessed by a book or a chart. When a family’s most urgent need is several years of intense therapy, neither 5210 nor any other combination of numbers will get the job done.

Your responses and feedback are welcome!

Source: “Save 20% on select AAP resources!,”, undated
Photo credit: Kevin McGrew via BY

Sweets and Tax in the United Kingdom

The struggle against obesity in the United Kingdom has been ferocious and divisive. Five years ago, the government announced that it was considering taxing unhealtful foods such as those containing sugar, salt, and saturated fats. This did not sit well with the freedom-loving Brits. After all, their country is where the Magna Carta and the principle of common law came from.

Two years ago, researchers at Cambridge University produced a study that was published in the British Medical Journal. The subjects were 5,000 people from the school’s immediate area, and it was said to be “the first to look at the combined impact of the home, work and commuting environments.” The report said:

Results from previous studies into the impact of takeaways on obesity have been inconsistent, but most of them focused solely on the residential environment. This study of 5,442 individuals in Cambridgeshire — which accounted for differences between the participants, for example in age, sex, household income, smoking and levels of physical activity — is the first to look at access to takeaway foods at home, work and journeys in between.

In the course of living a normal, everyday life in their own neighborhood, in the area of their work, and in the course of their commute, the average person was exposed to 32 “takeaway outlets” or what we in America call fast food restaurants. That is an average, implying that some people ran into a lot more temptation, while others had a much lower number of daily encounters with such establishments. The stunning result was that people at the top end of the exposure scale “were almost twice as likely to be obese compared with those who encountered the fewest takeaways.”

Those with the highest combined exposure to takeaway outlets consumed an extra 40g of calorific food a week (equivalent to half a small serving of French fries from a typical takeaway food outlet), and had a BMI on average 1.21kg/m2 greater than those least exposed. The association was most pronounced for exposure near people’s place of work.

The study also found that working near such places is more of a risk than living near them. The researchers were careful to note that they had not proven a causal link, but obviously they felt that the numbers were very suggestive. The implication was that the government should take measures to restrict takeaway outlets, especially near workplaces. At the same time, some local authorities had come intuitively to the same conclusion, and placed some restrictions, mainly around schools and in major business districts.

Unwarranted self-congratulation

At the same time, England was congratulating itself for having ONLY a 35% childhood obesity rate, as compared with fellow U.K. countries Wales and Northern Ireland, where 40% of children were found to be obese. U.K. member Scotland felt especially smug, with only a mere 33% child obesity figure. Consulting the Millennium Cohort Study, the same researchers noticed that children were at the highest risk for obesity between ages 7 and 11.

These and other studies inspired the Royal College of General Practitioners, along with an alliance of partner organizations, to suggest that the government create a new branch along the lines of the emergency taskforces formed to deal with national disasters, terrorism and the like. This idea was probably born from a feeling that the country should regard the childhood obesity epidemic as worthy of “state of emergency” status.

Your responses and feedback are welcome!

Source: “Tackling Takeaways could help cut obesity,”, 03/14/14
Source: “Childhood obesity surges between ages of seven and 11, study shows,”, 11/27/14
Photo credit: Internet Archive Book Images via Visualhunt/No known copyright restrictions

More About the Love Diet

Childhood Obesity News has been discussing the work of Drs. Connie Guttersen and
Mark Dedomenico, authors of The Love Diet. Their work has shown that no one can really overcome obesity until her or his underlying emotional problems are addressed, and in most cases the emotional problems revolve around the inability to love oneself.

They estimate that between 15% and 20% of overweight people are binge eaters, and that includes most who are classified as morbidly obese. Although the 20/20 Lifestyle Program does better than others, binge eaters are still the most challenging population segment, and there are even special groups for them within the program.

An old saying tells us “You can’t live on love,” but you certainly can’t live without it, either.
This is why 20/20 is so psychology-intensive. The object is to break the shame cycle so the patient can go on to develop self-acceptance, self-respect, and self-love.

A recommended strategy is the “act as if” method, known in some circles as “Fake it ’til you make it.” For instance, act as if you like to exercise. Patients are directed to “pretend, for the next two weeks, that you love yourself” and great things happen. Dr. Dedomenico says, “If we can just get people to like themselves, we’re halfway home to making them well.”

Life changes

What does a self-loving person do? She or he practices mindful eating, which can mean any one of a number of things, like the plate-size trick mentioned yesterday. Mindfulness is an important concept here, in the sense of thinking about actions rather than doing them automatically.

One example is the evening habit of drifting to the kitchen to browse among the cabinets or refrigerator shelves, but it can be broken in about two weeks. Drs. Dedomenico and Guttersen also explain the roles of planning and tracking in overall mindfulness.

In the eyes of these obesity experts, the microbiome is a major player. It appears that when obesity and diabetes (and even depression and anxiety) run in a family, it is because particular microbes were either passed along or were missing from the inherited mix.

Because gut bacteria are anaerobic, they are hard to study in a laboratory. Although we don’t yet know exactly which bacteria need to be present or their optimal proportions, still it does seem evident that when the species are out of balance, the bowel can absorb as many as 180 extra calories each day, which adds up to a 15-pound weight gain per year.

The pathogenic bacteria inside us are known to produce endotoxins, so 20/20 patients are urged to drink at least 64 ounces of water per day to flush that stuff out. Of course, this is not a unique perspective, as there is probably not a nutritionist on earth who would deny the importance of adequate hydration. Even on the most basic mechanical level, a stomach full of water can delay hunger.

Get a move on

Motion is essential. Not every morbidly obese person can immediately jump into gym workouts. But everyone should be taking at least 5,000 steps per day, with the intention of working up to 10,000. Any step total less than 2,500 Dr. Dedomenico dismisses as “sedentary.” He recounts the frustration he felt in the early days of this 24-year journey, when a group of women in the program stalled out and stopped losing weight.

After extensive and careful questioning, he understood what was going on. The women had changed their lifestyles, but not necessarily for the better. In fact, they had managed to prove that working out can, ironically, have negative consequences.

What happened was, all the women hired outside help for the gardening and housework they used to do. Meanwhile, they went to the gym in the morning and then rested on their laurels, or on something else, for the remainder of the day. Some of them were down to 1,500 steps.

After that, Dr. Dedomenico made sure to put a pedometer on everyone.

Your responses and feedback are welcome!

Source: “Cultivating Weight Loss Habits and Mindset,”, 08/04/16
Photo credit: Adam Engelhart via Visualhunt/CC BY-SA

The Love Diet

The High Intensity Health podcast #150 touches on quite a number of points that reflect the interests of Childhood Obesity News. In this episode, host Mike Mutzel interviews Drs. Mark Dedomenico and Connie Guttersen on the topic of “Cultivating Weight Loss Habits and Mindset.”

After developing coronary bypass surgery (with fellow cardiovascular surgeon Dr. Lester Sauvage), Dr. Dedomenico segued into a career whose aim is to prevent anyone from ever needing coronary bypass surgery. The next step was founding the 20/20 Lifestyle Program, which can actually reverse heart disease.

The staff includes not only physicians but registered dieticians, certified exercise professionals, and licensed counselors. The program can add 15 years to a patient’s life, just like bypass surgery — but without scalpel or sutures. The patient meets with a psychologist once a week for the first six weeks and attends group therapy 10 times while in the program.

Full-scale staff meetings discuss each patient individually, and success is measured by more parameters than just the scale. People stay with the program for various lengths of time to learn new ways of living, and their average weight loss is 1% to 2% per week. Dr. Dedomenico says:

We used to run insulin levels here on every patient coming in. They were all elevated, which means insulin-resistant. By the time they were finished with the program, there were no elevated insulins, so I quit doing them…

We get our diabetics totally off their medication 73% of the time. We get our hypertensives off of all their medications, normal blood pressure, 79% of the time.

As in Dr. Pretlow’s W8Loss2Go program, patients identify their trigger foods. An important step is to eliminate sugar, because once it finds its way into the body, sugar calls out for more sugar. Since carbohydrates turn into sugar, they are frowned upon. But an emotional eater will eat anything, and with most people, it all comes down to emotional eating.

The need for psychological tweaking was obvious from the start, because the problem is mainly in people’s heads, and originates from their lack of self-love. (In fact, Drs. Guttersen and Dedomenico recently published The Love Diet, a book that was 20 years in the making.)

The people in the patient’s environment are very important, which is why the program recruits them as allies. Childhood Obesity News has noted how parents can be enablers and saboteurs, and unfortunately this is also true of spouses and children, who may have some unconscious vested interest in keeping a relative overweight.

Stress and sleep deprivation are to be avoided, as are large dinner plates. Both doctors emphasized that standard plates used to be 9” in diameter, but now are more likely to be 12” or 14”. Eating from a plate, rather than directly from a processed food package, is important because it ties into the need for mindfulness. Putting food on a plate is a signal to be aware: “I am eating.” When a person grazes and nibbles from packages, this is all too easily forgotten.

(To be continued…)

Your responses and feedback are welcome!

Source: “Cultivating Weight Loss Habits and Mindset,”, 08/04/16
Sugar (red handles)
Photo credit: Lisa Risager via Visualhunt/CC BY-SA

Childhood Obesity News | OVERWEIGHT: What Kids Say | Dr. Robert A. Pretlow
Copyright © 2014 eHealth International. All Rights Reserved.