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Why We Get Fat (In All the Wrong Places) As We Age

Of all the questions about aging, inquiries about putting on weight as you get older is one of the most commonly asked. A typical answer from medical experts is that "it’s complex" – shorthand for "I don’t know.” And if they don’t know, then how can they help their patients? Well, let me simplify the answer for you, because aging doesn't mean you need to put on extra weight.

Fat cells are necessary: They keep you warm

First, let’s start with some background on fat cells. Fat cells have one primary purpose, which is to store fat and then release it for future energy production. Most of that energy simply keeps the body warm at 98.6 degrees. Prior to birth, the mother is doing most of the work to keep the fetus warm. After delivery, the newborn child has to keep themselves warm. This is why the number of fat cells tends to triple in the first six years of life, and then stabilize until the child reaches adolescence. Once you reach adolescence, your hormones start changing the game.

In females, an increase in estrogen causes the formation of new fat cells, as well as filling up existing fat cells with more fat on the hips, buttocks and breasts. This extra fat represents a potential energy reserve for lactation in case of pregnancy. Once adolescence is over for females, the formation of new fat cells and their increased filling virtually stops. This is why at age 25, females will have about twice the percent body fat and more fat cells than males.

The increase in testosterone in males will not increase new fat cell formation. After adolescence, the number of fat cells in both males and females remains about the same. Although the number of fat cells remains relatively constant for the rest of your life, the amount of fat that each one contains can be highly variable. This variability is a result of either aging, resulting in the decrease of estrogen or testosterone, or increasing levels of insulin resistance caused by increased inflammation. In either case, those unfilled fat cells start filling up.

It may not be the carbs, but inflammation that's the culprit

The real reason for increased fat gain after age 25 is increased insulin resistance. This condition is caused by increased inflammation in your insulin-sensitive cells, making it difficult for insulin to communicate its metabolic message to the interior of its target organs in the liver, muscles, and adipose tissues. This increasing insulin resistance forces the pancreas to produce even more insulin to try to get into the target tissues to respond. As a result, insulin levels rise in the blood and stay constantly elevated. In the case of fat cells in the adipose tissue, these constantly elevated insulin levels drive circulating fat into your existing fat cells as well as block the release of stored fat.

In essence, excess insulin caused by insulin resistance not only makes you fat, but also keeps you fat.

Contrary to popular thinking, carbohydrates don’t per se increase insulin, because insulin levels will rise and fall naturally when you eat carbohydrates as long as you don’t have insulin resistance. However if you have insulin resistance, then the levels of insulin in the blood will remain constantly elevated. The result is you will have increased fat deposition into your existing fat cells. What causes insulin resistance is not carbohydrates, but increased inflammation.

Even if you aren't gaining weight, you're still probably getting fatter

Why do we gain more fat as we age? The hypothalamus in the brain controls your energy-balance system which normally keeps your weight constant. This is known as your "genetic set point." Consider the hypothalamus as a weight control thermostat. However, the same inflammation that causes insulin resistance can also disturb that weight control thermostat in your brain. If it does, then any excess calories that you eat will be accumulated as extra body fat.

Typically, you gain about 1% of your body weight as additional fat each year after age 25. It only takes a 0.5% change in the weight control thermostat in the hypothalamus to cause that fat gain. That doesn’t seem like much, but if you weigh 180 pounds, that means you may be adding potentially 36 pounds of extra fat in 20 years unless you watch your calorie intake like a hawk and maintain an active exercise program. Virtually no one does after age 25 because life gets in the way.

Yet, although your body fat may be increasing, your weight might not change over the years because you are also losing muscle mass. Thus, your weight on the scale remains the same. This is when you'll begin to notice a change in your body composition by the fit of your clothes. This is why measurements like BMI that are based on weight are relatively poor markers of obesity, while my Body Fat Calculator will give you a more true measurement on your muscle vs. fat composition. Once you reach 25% body fat as a male or 35% body fat, as a female you can consider yourself obese regardless of your BMI.

News flash: Being obese is not necessary unhealthy

You heard it right. Simply being obese is not necessary unhealthy – as long as much of the extra body fat is subcutaneous fat under the skin, as opposed to visceral fat (i.e. belly fat). While there is a significant biological benefit of subcutaneous fat for females for pregnancy, it has little adverse effect on your metabolic health. This is why about 15% of obese individuals fall into the category of “metabolically healthy obese.”

In contrast, while it may taste good getting there, having a beer belly is not healthy. When you start seeing fat accumulate in your abdomen, you have visceral fat also commonly referred to as a "beer belly." Visceral fat, unlike subcutaneous fat, has nothing but adverse health effects. In particular, the higher the level of visceral fat, the more likely you will be to develop future chronic diseases such as metabolic syndrome (pre-diabetes), fatty liver, diabetes, and heart disease. So what causes you to accumulate visceral fat instead of subcutaneous fat as you age? If you guessed a combination of hormones and inflammation, you would be correct.

Hey Guys: Boosting testosterone doesn't need to weigh you down

We've known for more than 25 years that visceral fat in males is correlated with decreased levels of testosterone and increased insulin resistance.

Reducing insulin resistance is hard because you have to reduce inflammation and that requires following an anti-inflammatory diet for a lifetime. On the other hand, increasing testosterone is easy if you are using a drug. This helps explain why prescription sales of testosterone supplements increased more than 500% from 1993 to 2000. Today, testosterone supplement sales are greater than $2 billion dollars per year in the United States, and are estimated to reach $5 billion dollars per year by 2020.

There are three reasons why men take testosterone supplements:

  1. To get stronger
  2. To lose visceral fat
  3. To have more sexual vitality

But do testosterone supplements actually work? Science can answer that question.

In experiments where a condition of low testosterone levels (aka “low T”) was created in healthy young men with normal testosterone levels, and then their testosterone and estrogen levels were modified separately, increased testosterone levels increased muscle mass and strength. However, fat gain is actually due to deficiency in estrogen production, not lack of testosterone. As for sexual vitality, you need a combination of both testosterone and estrogen. So what's a guy to do? All of this illustrates that controlling body fat in males is a little more complicated than just supplementing with testosterone.

In men older than 65 and with “low T,” in experiments where their testosterone levels were elevated to those of 30 year-old men, there were significant benefits in sexual function. However, existing erectile dysfunction drugs did a better job than testosterone supplementation. Increased testosterone did minimal benefits in mood and depression, and no benefit in leg strength (measured by distance they could walk in 6 minutes), nor on their vitality. Not very encouraging results.

I am sure these relative pathetic results will not negatively affect testosterone sales. Why? This is just another case on how drug marketing hype trumps real science.

Hey Ladies: Estrogen may make you look younger, but there's a price

What about estrogen for women to reduce visceral fat? Visceral fat is not associated with estrogen deficiency, but with an excess of free testosterone. Most of the testosterone and estrogen in both men and women is bound by sex hormone binding globlins (SHBG) that control the levels of the free hormone that can interact with its receptors. Therefore, as levels of SHBG decrease, there is an increase in free testosterone in women. This helps explain why oral estrogen supplementation made women look younger, because the oral estrogens increased SHBG levels and that caused a decrease in free testosterone. As the free testosterone levels in women taking oral estrogens dropped, so did their levels of visceral fat. The end result, they looked younger. Of course, taking prescription oral estrogens increase your likelihood of cancer, but many consider that a small price to pay for looking thinner and younger.

Forget hormone supplements and focus on reducing insulin resistance

If taking prescription estrogen is not the answer to reducing visceral fat in females, then what about going back to reducing insulin resistance by the diet? That approach works. The elevated insulin coming from insulin resistance causes a decrease in SHBG levels in females. Bottom line: if you reduce your insulin levels, you lose fat.  This is true for both males and females.

The only way to reverse insulin resistance is to follow an anti-inflammatory diet.

We hear a lot about insulin resistance, but very little on how to reverse it. Yet, you can improve your insulin resistance in just a few days of significant calorie restriction (about 1,100 calories per day). The only problem is that you have to do this for lifetime without hunger or fatigue, and reducing calories by that much forever will make you starve to death, right?

The best way to reduce insulin resistance remains an anti-inflammatory diet like the Zone Diet. This means a calorie-restricted diet that is protein-adequate, moderate in carbohydrate, and low in fat especially pro-inflammatory fats such as omega-6 fatty acids and saturated fats like palmitic acid. Using Zone Pasta as your primary protein source for your Zone meals makes it easy to follow for a lifetime, and our recent clinical trials strongly supports that statement. And guess what? You'll never be hungry.

Say goodbye to beer bellies and cellulite

Other benefits of reducing insulin resistance include a decreased likelihood of diabetes, heart disease, and Alzheimer’s. Yet, most men remain more concerned by their beer bellies, while women remain concerned by their cellulite – because this weight can be seen in the mirror right now.

Cellulite appears when fat cells in the subcutaneous area like the buttocks expand and push through the dermis giving a puckering effect to skin. You see this protrusion because the skin that surrounds the buttocks is thinner than the skin that surrounds the abdominal area. This is why males and females with a beer belly don’t have cellulite in the abdominal region, but with a little effort (like packing on more pounds), men also can develop cellulite.

The solution to both cellulite and beer belly is the same: The Zone Diet.{{cta('cd305230-6e34-42f6-9e2c-c2beda556f50')}}References:

  1. Sears B and Perry M. “The role of fatty acids in insulin resistance.” Lipids Health Disease 14:121 (2015).
  2. Finkelstein JS et al. “Gonadal steroids and body composition, strength, and sexual function in men.” N Engl J Med 369: 1011-1022 (2013).
  3. Synder PJ et al. “Effects of testosterone treatment in older men.” N Engl J Med 374611-621 (2016).
  4. Sears B. The Anti-Aging Zone. Regan Books. New York, NY (1999).
  5. Janssen I et al. “Testosterone and visceral fat in midlife women.” Obesity 18:604-610 (2010).
  6. Serin IS et al. “Long-term effects of continuous oral and transdermal estrogen replacement therapy on sex hormone binding globlin and free testosterone levels.” Eur J Obstet Reprod Biol 99:222-225 (2001).
  7. Onat A et al. “Serum sex hormone-binding globulin, a determinant of cardiometabolic disorders independent of abdominal obesity and insulin resistance in elderly men and women.” Metabolism 56:1356-1362 (2007).
  8. Akin F et al. “SHBG levels correlate with insulin resistance in postmenopausal women.” Eur J Intern Med 20:162-167 (2009).
  9. Winters SJ et al. “Sex hormone-binding globulin gene expression and insulin resistance.” J Clin Endocrinol Metab 99:E2780-2788 (2014).
  10. Markovic TP et al. “The determinants of glycemic responses to diet restriction and weight loss in obesity and NIDDM.” Diabetes Care 21:687-694 (1998).

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062524---Keto-Blog

Ketogenic Diets and Aging

Chances are, you or someone you know has tried the keto diet at some point in time. This high-fat, very low-carbohydrate eating plan appeals to many due to its promise of rapid weight loss. In this blog, Dr. Sears explores some of the latest scientific findings on ketogenic diets and provides caution before hopping on this trend. What is a Ketogenic Diet? The ketogenic diet is a high-fat, very low-carbohydrate eating plan. This significant reduction in carbohydrates to induce a metabolic state is called ketosis. This only occurs when there is not enough carbohydrates in your liver to completely convert fatty acids to carbon dioxide and water. The normal conversion generates the chemical energy (ATP) that keeps us alive. In the absence of ketosis, each fatty acid generates 108 molecules of ATP when oxidized in the mitochondria. Ketone bodies make less ATP when they are metabolized by mitochondria. How much less? About five times less. This is like switching the gasoline in your car from high-octane fuel to low octane fuel as ketone bodies increase in the blood. Furthermore, contrary to popular belief, ketones are not an ideal energy source for the brain, as glucose remains the preferred fuel for ATP production in brain cells. Lack of blood glucose is a highly stressful situation for the brain. This is why the body secretes the stress hormone cortisol from the adrenal glands during ketosis to breakdown protein and convert the amino acids into glucose for the brain. This explains why even under complete starvation for 38 days, the blood glucose levels never dropped below 68 mg/dL. This is still considered as a normal blood sugar level. Where did this blood glucose come from if there was none in the diet for 38 days? The answer is neo-glucogenesis primarily using lean body mass. Ketogenic Diets Pros and Cons Interest in ketogenic diets rises and falls about every 20 years. They’re very low-carbohydrate diets that claim that carbohydrates make you fat and keep you fat. This is simply not true. It is not carbohydrates per se but a disrupted metabolism that makes you fat. To be more specific, it is the inhibition of AMPK, the master regulator of your metabolism that makes you fat. Why? As AMPK activity increases, you burn stored fat faster. Frankly, I’ve always been amazed by the re-emergence of ketogenic diets. Eighteen years ago, I published the premier clinical study demonstrating that, under equal calorie intake in which all the food was provided to the subjects for six weeks, the Zone Diet was better than a ketogenic diet in reducing total weight, excess body fat, and inflammation. Now, a recent study revealed some more very concerning findings about the long-term effects of ketogenic diets. This new study indicated that following a keto diet causes a rise in senescent cells, popularly known as “zombie cells.” Zombie Cells are damaged cells that no longer divide but don't die. That’s bad enough, but zombie cells continue spreading inflammation throughout the body. As the number of zombie cells increases in your body, they become a living nightmare. Why? Zombie cells accelerate aging because they cause the earlier development of many chronic diseases. In this study they found that zombie cells in the animals began to appear while they were on a ketogenic diet. The zombie cells then disappeared when researchers changed the diet to a “non-ketogenic diet” (i.e., the Zone diet). And when the animals were given a Keto diet again, the zombie cells reappeared. Notice a trend? If you want to hear more about this study you can listen to our recent podcast at Dr.Sears.com. Based on earlier blogs, this adds to the list of downsides for following a ketogenic diet versus the Zone Diet. PROS Rapid initial weight loss: This is primarily due to the loss of retained water from the glycogen stores in the liver, which is rapidly used up to maintain blood sugar levels. Since these glycogen stores in the liver contain significant levels of retained water, much of the initial weight loss is water rather than stored body fat. If your main goal is loss retained water, this can be seen as a benefit. Of course, going to a sauna would also work. Reduced hunger: Ketogenic diets are rich in protein. Any increase in protein intake can help reduce hunger. CONS Production of acetone: One of the ketone bodies produced during ketosis is acetone, which is also the main chemical in nail polish. Increased calcium loss: A ketogenic diet can lead to higher calcium loss from bones. Limited fat utilization: High levels of dietary fat reduce the likelihood of using stored body fat for energy unless you also significantly restrict calories. Reduced energy levels: The lack of ATP production on a ketogenic diet can lead to easier fatigue during mild exercise. Damage from cheat meals: After seven days on a keto diet, a single high-carb cheat meal can damage blood vessels. Lack of polyphenols: This makes it difficult to activate genes that optimize metabolism by improving mitochondrial efficiency in converting fat into ATP. No long-term weight loss advantage: Long-term studies show no difference in weight loss between a ketogenic diet and a low-fat, high-carb diet. No short-term metabolic advantage: Careful studies demonstrate that fat loss on a ketogenic diet is the same as on a low-fat, high-carb diet with the same caloric intake. Compromised gut health: A lack of fermentable fiber from carbohydrates can lead to poor gut health and an increased risk of developing a leaky gut, which can cause significant inflammation. Furthermore, short-chain fatty acids (SCFA) are the metabolic product of fermentable fiber. These SCFA are powerful epigenetic signaling agents that enhance gene transcription. Ketosis generates a different type of hydroxylated short fatty acid (3-hydroxyl butyrate, that has no effect on gene transcription. In addition, the lack of SCFA has significant negative consequences on the gut-brain axis. Cortisol build-up: To produce glucose for the brain, cortisol levels increase to breakdown protein to make sufficient glucose via neoglucogenesis. Excess cortisol can lead to insulin resistance that cause regain of some of initially loss body fat. In addition, increased cortisol levels cause a depressed immune system as well as destruction of memory cells in the hippocampus. The initial benefits of following the ketogenic diet result in some initial weight loss (primarily water weight rather than fat loss), long-term studies show no significant differences in overall weight loss. Now new findings show a ketogenic diet may lead to significant adverse health consequences by accelerating the formation of zombie cells. Call me crazy, but I feel the key to longevity and wellness comes down to better metabolic control instead of living in a constant state of ketosis. Following Metabolic Engineering® for a lifetime provides that pathway of losing body fat without ketosis. References 1. Johnston CS, Tjonn SL, Swan PD, White A, Hutchins H, and Sears B. “Ketogenic low-carbohydrate diets have no metabolic advantage over nonketogenic low-carbohydrate diets.” Am J Clin Nutr 2006 83:1055-61. 2. White AM, Johnston CS, Swan PD, Tjonn SL, and Sears B. “Blood ketones are directly related to fatigue and perceived effort during exercise in overweight adults adhering to low-carbohydrate diets for weight loss: a pilot study.” J Am Diet Assoc. 2007 107:1792-1796. 3. Sung-Jen Wei, Joseph R Schell, E Sandra Chocron, Mahboubeh Varmazyad, Guogang Xu, Wan Hsi Chen, Gloria M Martinez, Felix F Dong, Prethish Sreenivas, Rolando Trevino Jr , Haiyan Jiang, Yan Du, Afaf Saliba, Wei Qian, Brandon Lorenzana, Alia Nazarullah, Jenny Chang, Kumar Sharma, Erin Munkácsy, Nobuo Horikoshi, David Gius. Ketogenic diet induces p53-dependent cellular senescence in multiple organs. Sci Adv. 2024 May 17;10(20):eado1463. doi: 10.1126/sciadv.ado1463. 4. Owen OE, Felig P, Morgan AP, Wahren J, Cahill GF Jr. Liver and kidney metabolism during prolonged starvation. J Clin Invest. 1969 Mar;48(3):574-83. doi: 10.1172/JCI106016. 5. Chriett, S., Dąbek, A., Wojtala, M. et al. Prominent action of butyrate over β-hydroxybutyrate as histone deacetylase inhibitor, transcriptional modulator and anti-inflammatory molecule. Sci Rep 9, 742 (2019). https://doi.org/10.1038/s41598-018-36941-9. 6. Silva YP, Bernardi A, Frozza RL. The Role of Short-Chain Fatty Acids From Gut Microbiota in Gut-Brain Communication. Front Endocrinol (Lausanne). 2020 Jan 31;11:25. doi: 10.3389/fendo.2020.00025. 

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050824---Tofu-Blog

Tofu: Tips and Recipes Ideas

I have been eating tofu for a very long time, much longer than the 30 or so years I have been following the Zone Diet. Back then many of my favorite recipes came from the Tassajara cookbooks by Edward Espe Brown, the celebrated chef from the kitchen at California’s famous Zen Mountain Center, and cookbooks by Louise Hagler, a.k.a. Wendy Louise, a well-known authority on vegetarian cooking who is associated with a community in Tennessee known as The Farm. Those books are still among the best resources for tofu recipes. My mantra has always been if you don’t like something, don’t eat it. Keep this in mind if you’re new to tofu, start slowly by combining it with flavors and foods you like.    Tips and Suggestions    Firm-sprouted tofu is my preference for the Zone Diet. Unlike traditional tofu, which contains significant amounts of both protein and carbohydrate, sprouted has almost no carbohydrates. It’s lighter tasting, refreshing, and very filling.   Freezing tofu results in a chewy, sponge-like texture. I don’t recommend freezing, but some people prefer it when using tofu to substitute for meat in a recipe.    Baked tofu comes in a variety of flavors and makes an excellent quick meal with some vegetables and fruit added. It’s also great in salads.     Tofu made it into the book “The Top 100 Zone Foods” by Barry Sears.    Some recipes call for draining the tofu first. I find that usually isn’t necessary.   Tofu takes on the flavor of whatever is added to it.    Add nutritional yeast flakes to give a cheesy flavor to vegan tofu scrambles and dips. It’s also rich in protein and vitamin B12.   Cherry Vanilla Tofu “Ice Cream”   Tip: This doesn’t freeze or store well, so prepare only the amount you plan to serve immediately.   Using an immersion blender or a food processor blend equal parts of frozen dark cherries and firm tofu, plus some vanilla extract (preferably alcohol-free for best flavor). Serve immediately.  Tofu Scramble  This is great for breakfast, lunch, or dinner, and we’ve even brought it on long day hikes for a snack.   Crumble some firm tofu and stir in a generous amount of seasonings, taking care not to overdo it with the salt. Heat in a well-seasoned or nonstick skillet with a little Zone-friendly oil to the desired doneness.    Optional: If time allows, sauté some chopped onion in the skillet before adding the tofu and seasonings.    My favorite seasoning combination for this dish at my house is onion powder, garlic powder, turmeric, paprika, some oregano or thyme, nutritional yeast flakes, salt, and ground black pepper. The yellow color of the turmeric makes it somewhat like scrambled eggs.   Tofu Veggie Almond Pasta Salad   Dressing: Thin some smooth almond butter by stirring in some water, a little vinegar, and either soy sauce or Bragg’s Liquid Aminos (an unfermented soy sauce found in the health food section of most grocery stores).    Toss together cooked Dr. Sears’ Zone PastaRx Fusilli, tofu cut into cubes, matchstick cut red bell pepper, chopped green parts of scallions (a.k.a. green onions), and the almond butter dressing. Serve immediately or chill to serve later. It will keep well in the fridge for two or three days.   Use your imagination and see what you can come up with.  Experiment and have fun with it. Try using tofu to make cheesecakes, whipped desserts, tofu chocolate pudding, tofu “cream” based soups, tofu pot pie (think chicken pot pie), tofu burgers, tofu burritos, Buffalo tofu (like Buffalo wings), layered Mediterranean dips, tofu “meatballs”, grilled tofu, and more.    Enjoy! 

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