The Wild Health Take: Week Five

Each week Dr. Carl Seger listens to your favorite podcasts to summarize the data and give you our precision medicine take.

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‍Who: The DRIVE with Peter Attia, MD

What: Episode #212, The Neuroscience of Obesity

1. Like many things related to our health, weight loss can be nuanced. Our bodies have a regulation system that ensures we don’t lose weight if the body has adapted to a certain “set point” weight. This doesn’t mean that we will be unable to lose weight, but this can help to explain why some people struggle with weight loss, whether that is losing weight or keeping it off long term.
2. Susceptibility for obesity has been in our genome for a long time- this may have been more advantageous as hunter-gatherers to store excess body fat in case of times of famine. We didn’t see many obese hunter-gatherers, however, because their environment was not set up for obesity to flourish the way our current environment is. With more sedentary lifestyles, and an abundance of hyper-palatable foods, we are in the optimal environment for obesity to flourish, especially in those of us who have inherited 1-2 risk alleles in SNPs associated with obesity.
3. Our bodies are hardwired around energy acquisition in terms of how we learn and our motivations on a subconscious level. This causes hyper palatable foods to be more appealing, thus leading our bodies to look for them more often. We can relearn our “old ways” of eating by shifting our foods away from hyper-palatable, overly processed food products to whole, unprocessed foods. The more we consistently reach for whole and unprocessed foods, the less our brains will look for the hyper-palatable ones.
4. The reason we sometimes see high weight loss with Keto, Carnivore, or low fat/high carb diets is because these diets focus on the extremes. Extreme fat or carbohydrate restriction will naturally lead to weight loss, however these are unsustainable long term. While the extremes may be beneficial for some, for most, they may not be best because of the lack of sustainability.
5. For patients that have a high BMI (over 35), consider medical intervention combined with diet and lifestyle changes to support long term weight loss. For patients that are overweight, but not yet obese, focus on creatine diet and lifestyle changes that rewire the subconscious brain signals to support healthy habits. For these patients, it may include changing their food environment (what foods are readily available), how hard you have to work for the food, the dopamine response from the food, and/or how the food is eaten (sitting at the table vs. on the go).

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How: There is a lot of additional neuroscience information in this podcast that is easy to get wrapped up in. Creating the understanding that sometimes, it’s not actually about food, and that there are other factors at play can be helpful as we work towards better health. A helpful resource from the podcast is Red Pen Reviews, a nonprofit organization created by Stephan Guyenetwhich fact checks nutrition books that have been published.

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Who: Andrew Huberman Ph.D., Professor of Neurobiology and Ophthalmology at Stanford School of Medicine

What: The Science and Practice of Movement

1. There are aspects of our nervous system, muscular system and connective tissues that work to restore the placement of limbs on our bodies. Flexibility and the process of stretching our limbs involves these same neural, muscular and connective tissues. Lower motor neurons in the spinal cord send a set of “wires” to muscles and create a neuromuscular junction where a chemical, called acetylcholine, is released onto the muscles that causes them to contract. Our limbs move through space by adjusting the angles of our bones through muscle contraction, flexion and extension. There are two protective mechanisms that ensure that the range of motion of our limbs is maintained to avoid injury. Sensory neurons within the muscle, called spindle neurons, wrap around muscle fibers which sense the amount of stretch. This sensory information is sent back to the spinal cord and the brain. If a given muscle is stretching too far, another muscle contraction is stimulated which returns the limb to a safe range of motion. Another mechanism has some of the same features, but deals with sensing loads.  At the ends of each muscle are tendons where Golgi Tendon Organs (GTO’s) sense the load on a given muscle. GTOs send electrical signals to the spinal cord which prevents contraction of a given muscle if its ability is exceeded. Both of these protective mechanisms, one sensing stretch and one sensing loads, are important and can be leveraged to increase and improve limb range of motion.

2. Further up our nervous system, in the brain, there is an area called the insula. This area integrates sensory inputs and internal somatic experience. In the posterior insula there is a set of large neurons called von economo neurons. These neurons have the unique property of integrating knowledge of our body movement and sense of pain or discomfort. It can then regulate our motivational processes and encourage us to lean into discomfort if it is directed toward a specific goal. The von economo neurons are closely tied to our sympathetic nervous system and parasympathetic nervous system, whereby we can decide to “relax” into a stretch and activate the parasympathetic nervous system to allow override of the spindle mechanisms in our muscles for deeper stretching.

3. There are many health benefits of a stretching practice to increase limb range of motion (ROM). Stretching can help offset age-related loss of flexibility (about 1% per year after the age of 20), can improve physical performance, improve balance, improve muscle tightness and posture, all which are key features of longevity. Good limb ROM can also be beneficial for reducing pain with movement and helps us remain mobile throughout life. The different types of stretching are defined as dynamic, ballistic, static and proprioceptive neuromuscular facilitation (PNF). Both dynamic and ballistic require some element of momentum, while static involves actively or passively holding a position in stillness. PNF may use props or people to stretch a muscle, contract against resistance, and stretch again. Research has shown that for increasing range of motion long term, static stretching is the most effective.

4. Further studies have shown that very low intensity stretching, achieving a threshold of 30-40% (where 100% is the point of pain), was more effective at increasing ROM than those who achieved a threshold of 80% for a 6 week study. Also referred to as micro-stretching, low intensity static stretching supports the idea that it does not have to be painful to be effective. Other research has shown that whole body micro-stretching reduces stress, improves relaxation through parasympathetic activation. Study has shown that it could also reduce tumor volume in mice by up to 50%. It is believed that this is achieved through an inflammatory and immune response pathway in response to the stretching.

5. Studies of yoga practice have shown that there is a dose response curve whereas practitioners of yoga had an increase in gray matter in the insular cortex and a subsequent ability to tolerate, understand, utilize, lean into and overcome pain. The gray matter volume scales, in a linear way, based on amount of practice. Pushing to the end ranges of motion and discomfort builds up the insular structure and function to cope with other pain sensations.

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How: Although controversial, stretching before running or strength training can help us achieve proper form and is therefore beneficial for safety and confidence, even if it may slightly reduce speed of running or the amount of weight being lifted/moved. It is generally best to stretch after raising the core temperature with 5-10 minutes of cardiovascular exercise.  The protocol for static stretching to achieve lifelong benefits is an accumulation of 5 minutes each week per muscle group, spread across at least 5 days per week or more. This means 2-3 sets of 30 second holds for each muscle group 5-7 days per week has been proven effective at maintaining or increasing limb ROM across the lifespan.

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Who: High Intensity Health with Mike Mutzel, MS

What: Why You Should Donate Blood to Reduce Blood Viscosity, Iron Overload, and Cardiometabolic Disease Risk

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1. Phlebotomy can be beneficial for those with elevated ferritin and hemoglobin. It is commonly seen in men and postmenopausal women.
2. Excessive iron is stored in the liver, pancreas, and heart and can impact your brain. Donating blood twice a year lowers stored iron levels.
3. Insulin and hyperinsulinemia influences change in iron metabolism, absorption and physiology. It also affects ferritin metabolism.
4. Iron is a mineral that is essential for oxygen transport in hemoglobin. It increases in your body due to breakdown of red blood cells. 90% of daily iron needs comes from the breakdown of red blood cells. The other 10% is thought to be from dietary sources.
5. Iron overload is the catalyst for the formation of oxidized low-density lipoproteins, causing more free radical damage in the body in an inflammatory metabolic environment.

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How: Suggests the use of blood donation to decrease ferritin and iron overload in patients with elevated labs.

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