Image 1: Without exercise and a healthy diet your fight against body fat is as desperate as Heracles fight against the Hydra without the help of his nephew Iolaus.
After yesterday's blogpost on the Biggest Losers, who - upon closer scrutiny - were not so bad of, as many people in the health and fitness community would have it, we will take a look at a more convenient and (accordingly *sigh*) increasingly popular way to get rid of the nasty lovehandles: Liposuction, or the costly reduction of subcutaneous body fat with a hopefully 100% sterile vacuum cleaner ;-) Aside from the risks that are directly related to the operation, a group of Brazilian researchers right from the mecca of plastic surgery, Sao Paulo, has just published a paper (2 days ago, to be precise) on another, hitherto totally overlooked side effect that arose subsequent to a small-volume tumescent abdominal liposuction (1240.3ml) in the sedentary half of 36 physically inactive (i.e. not engaged in any form of regular physical activity program for at least 6 months), yet non obese women (20 –35yr) who participated in the study (Benatti. 2012)
Remove it here, regrow it there. Body fat resembles the Hydra from Greek mythology
In order to control the outcome of the operation itself and its long(er) term consequences in the presence or absence of a physical exercise program that was conducted for four months starting 2 months after the OP (this yields a total duration of 6 months for the whole study), the Fabiana Benatti and her colleagues assessed the total body fat and fat-free mass of the participants via hydrostatic weighing and used computer tomographs to determine the size of the individual fat depots.
Figure 1: Changes in body composition relative to baseline (data calculated based on Benatti. 2012)
As you can see in figure 1 the comparatively reasonable exercise program the subjects in the training group (TR) performed three times per week during the last four months of the follow-up period and which consisted of a...
5-min warm-up followed by
strength exercises: 8 exercises for the major muscle groups, 3 sets of 12 reps, and
aerobic exercise on the treadmill: 30-40min at 75% of the VO2max
led to further reductions in subcutaneous fat mass. From a non-aesthetical perspective, it is yet more important that the three weekly exercise sessions prevented the vicious repartitioning effect from the subcutaneous to the visceral body stores, the cosmetic surgery had on the adipose tissue of the the women in the sedentary group (NT) in the course of the 4 months after their surgery.
Could it be that taking the easier way out is always a bad idea?
Image 2: Does look nasty, is not without risk and not effective in the long run - liposuction.
These results are interesting, because they do confirm the long-touted notion that plastic surgery would be pretty useless, if it is not combined with an adequate exercise and nutrition program. Moreover, the novel finding that the compensatory effects, i.e. the regrowth of body fat, does not take place in the subcutaneous fat depots, but in the vicinity of the organs, i.e. in the dreaded visceral adipose tissue stores, sheds an even more unfavorable light on a convenient, yet expensive, ineffective and - as this study shows - profoundly unhealthy attempt to "looking good naked".
The further reduction in subcutaneous fat and the absence of this highly unfavorable "repartitioning effect", on the other hand, speak to the effectiveness of a combined strength and endurance training program for female and, as we know from countless of other studies, also male weight loss - and that in the absence overtly restrictive eating.
Clear results with surprising effects on CVD risk and energy expenditure
Still, there are a few downsides and shortcomings to this study that should not be overlooked. Firstly, the scientists did not evaluate the body fat distribution in the upper body, specifically the breasts. Whether there may have been a repartitioning effect from the abdominal to the upper body (e.g. breast, back and arms) subcutaneous fat depots, thusly remains to be elucidated. Moreover the increase in total LDL count, the scientists observed in the non-training group was not accompanied by increases in ApoB levels, which are considered as a relatively reliable marker for the number of the allegedly artery-clogging small LDL particles. Whether the women in the study are thusly actually facing an increased risk for cardiovascular disease or simply carry ~10% more visceral body fat around is about as questionable as the underlying cause of the reduction in energy expenditure that went hand in hand with the loss of ~1kg of subcutaneous body fat in the absence of a reduced caloric intake.
Figure 2: Significant (non-training, p = 0.01) and non-significant (training, p = 0.82) changes in doubly labeled water measured energy expenditure 6 months after liposuction (data adapted from Benatti. 2012)
In the end, the data in figure 2 relates directly to what we have seen in yesterday's analysis of the metabolic effects of a -60% reduction in body fat (cf. "Metabolic Consequences of Extreme Weight Loss"). If we assume that the 7-day food diaries provide an accurate estimate of the energy intake (if anything those logs usually underestimate / the participants underreport energy intake) and rely on the exactness of the relatively reliable doubly labeled water method you already know from yesterday's Biggest Loser study, the ~100kcal reduction in energy expenditure in the study at hand cannot be induced by restrictive eating (and in the non-training group obviously not by excessive exercise ;-), so that the Brazilian scientists conclude that...
our data suggest that the fat loss per se plays a role in decreased energy expenditure because no changes in food intake, lean mass, or leptin levels were observed.
And call for "[a]dditional studies" to "comprehensively explore the underlying mechanisms of the liposuction-induced decrease in energy expenditure". In view of the fact that these results could be of fundamental importance not only for the lazy plastic surgery patient, but also for the hard-training physical culturist who strives to push his / her body fat levels lower and lower, you can be certain that the SuppVersity is the place, where you are going to read about the results of future investigations into the underlying mechanisms first!
Believe it or not a soon-to-be published study that was sponsored by a the German LBS and presented to the public two days ago found that 1 out of 20 German kids below the age of 14 thinks about having liposuction done (figures based on LBS Kinderbarometer. 2013).
5% that's the SuppVersity Figure of the Week and it's the percentage of German kids below the age of 14 years who are thinking about getting liposuction done. I am not sure, whether I should feel sorry or enraged... not about the kids obviously who probably feel miserably in their own skin, but for the parents, the food industry and the government with their "expert" advisers whispering into their left ear and the junk food industry lobbyists who are holding a megaphone to the politicians right ear and a razor-blade to their throat. I guess, I'll settle for both, feeling sorry for the kids and being mad at the adults.
But enough of this let's get to some recent science news. Let's see... oh yeah, why don't we just start out with something 15% of the German kids (this is the number of already obese kids) are probably going to need sooner or later: diabetes medication.
Metformin not unique, green tea just as effective?!
(Sundaram. 2013) -- I know this sounds almost like a marketing scam from some snake oil... ah, green tea vendor, but according to a soon-to-be-published paper in Phytomedicine does have almost identical effects on the glucose metabolism of diabetic (streptozotocin + high at diet = std. model of type II diabetes), as metformin does.
Figure 1: Glucose and insulin levels in healthy and streptozotocin induced diabetic rodents receiving different doses of green tea (75, 150, 300mg/kg) or metformin (500mg/kg; Sundaram. 2013)
In fact, a short glimpse on the data in figure 1 should suffice to tell you that green tea is on a mg/mg basis even more potent than metformin. I would still caution any true diabetics out there not to drop their medication for the endproduct you get if you buy1 kg of fresh green tea leaves from the plant C. sinensis from the Nilgiris, India, dry them in the shade for two weeks, pulverize them and finally create a 1:10 ethanol extract, store that in the fridge for one week and then finally filter and evaporate it at a temperature of <50°C.
Did you know that the macronutrient composition (esp. the protein content) can have major impacts on your neurotransmitters and mood? No, then revisit this older SuppVersity article and learn more.
Not diabetic, then you may be interested in this: A non-negligible side note of the study at hand is that the GTE that was so good for the sick rats, did nothing, I repeat, absolutely nothing for the glucose metablism of the healthy rats on the high carb, low fat chow. Still, a recent study from Japan suggests that your psychological well-being (not tested in the rodents ;-) alone would justify the consumption of one, two or even three cups of green tea or coffee per day (Pham. 2013). After all, Pham et al. observed in their most recent study which is going to be published in one of the future installments of the peer-reviewed journal Public Health Nutrition that both, green tea and coffee consumption are inversely related with the odds ratio of depression in the Japanese working population. In this case, the scientists are yet pretty sure that it's none of the fancier components, but simply the caffeine content that is responsible for the >40% reduced risk of depression in tea/coffee aficionados.
You may be asking yourself why I mention the lengthy procedure of preparing that extract, right? Well, different source, different preparation methods, different effects. This and the fact that a human diabetic is not a streptozotocin treated rodent of a high fat diet put a huge question-mark behind and premature conclusions like "green tea is a better anti-diabetic than metformin".
After all those years, 1-Andro still works.
(Granados. 2013) -- It is certainly debatable in how far this qualifies as "news", after all, 1-androsterone is the "mother of all prohormones", but I still guess that one or another of the average muscle heads out there will still be intrigued to hear that researchers from the Human Performance Research Laboratory of the Department of Sports and Exercise Sciences at the West Texas A&M did actually dare to test the effects of 330mg/day 1-AD, which were administered for 4 week with 16 session of a structured RT program, on the physique and health of 16 males (23±1yrs; 13.1±1.5%BF; 5.3±1.0yrs RT experience; the 1-AD used in the study was probably that of a larger US producer that's still available online and has a slightly different nomenclature, i.e. 3-hydroxy-5alpha-androst-1-en-17-one).
Figure 2: Relative changes in muscle mass (total change above the bars) and kidney, "liver" and lipoprotein metabolism after four weeks on a 1-AD clone (Granados. 2013)
The results I plotted for you in figure 2 actually speak for themselves: Increases in lean mass and strength on the positive and deteriorations of the kidney (creatine), liver (S-GOT) and lipid metabolism (HLD, LDL, total cholesterol) are exactly what you can expect from a mild prohormone like this.
EPA triggers protein synthesis and inhibits breakdown... in the petri dish
CLA and fish oil, are they "anabolic" in human trials (learn more)?
(Kamolrat. 2013) -- You will probably remember the SuppVersity article on the potential "anabolic" effects of fish oil and CLA from February, 25, 2013, where not a single of the human studies showed beneficial effects of fish oil supplementation on training induced muscle gains, right?Well, a soon-to-be-published paper from the Biochemical and Biophysical Research Communications does at least confirm that Maculoso et al. were not totally off the track, when they suspected that fish oil could be "anabolic". Contrary to their hormonal understanding, the results of the study at hand do yet suggest that high serum concentrations of EPA may increase the expression of local control factors of protein synthesis in a way that does not necessarily render them anabolic, but would suggest that they may help people with muscle wasting disorders.
If you take a look at the data in figure 3, which holds all the statistically significant effects the scientist observed, the most important advantage of EPA vs. DHA in murine C2C12 myotubes after L-leucine stimulation unquestionably is the EPA-specific decrease in protein breakdown.
Figure 3: Protein breakdown, marker of protein synthesis and apoptosis in EPA or DHA treated C2C12 myotubes in the petri dish (Kamolrat. 2013)
What the scientists don't tell you though is that the effect size may be negligible, that the enhanced anti-protein breakdown (note:protein breakdown does not equal cell death) effects are only present when the cells are incubated with leucine and - most importantly - that FOX3a, which was likewise significantly elevated, "is necessary and sufficient for the induction of autophagy in skeletal muscle in vivo" (Mammucari. 2007), is upregulated in catabolic states of testosterone deficiency (White. 2013), and is suppressed by HSP70 (heat shock protein expressed in response to eustress such as exercise; cf. Senf. 2008). No wonder no human trial was ever able to demonstrate the anabolic effects of fish oil.
Once again, I am not trying to make you panic about the individual serving of whatever is on the following list. The current state of research clearly suggests that the individual contribution of endocrine disrupting plastics from each of these items is way below what can harm an adult (and sexually mature) individual. When I went through the latest data Arnold Schecter et al. present in their latest paper in Environmental Health Perspectives, there were - for my liking - still too many patterns emerging to simply ignore this paper (I cannot simply copy & paste all the data, but the you can download the supplemental data here):
Figure 4: The metabolites of all measured phtalates in a 2012 study from the Columbia University were significantly elevated in 56 infertile vs. 56 fertile couples (Tranfo. 2012). I know, correlation is not causation, but I would venture the guess that none of the 1/6 couples who are infertile (McArthur. 2007) will care about the difference...
Pork, the supposedly unhealthiest meat source has the highest estimated mean phthalate concentration of any food group.
The "good apple" juice of which Dennison et al. report that daily intakes equal or greater than 12 fl oz/day are associated with shortstature and with obesity in two and five-year old children in New York (Dennison. 2013), is topped in terms of its phthalate content only by diet lemon tea - another of those "healthy" beverage.
The "healthy" vegetable oils are the absolute #1 dietary source of BBzP, of which a group of researchers from the Columbia University has only recently been able to show that children who were exposed to BBzP prenatally had a >50% higher risk of developing eczema within the first 2 years of their lives (Just. 2013).
I guess, I could cite a couple of other "happy coincidences", but I don't want to bore you away, before we get to something that should really make us reconsider the convenience of our "Plasti-Nation(s)", specifically the convenience of getting "scientifically formulated baby foods" for your children.
Figure 5: Dietary exposure (in µg/kg body weight; calculated on average intake of the various food items) from beverages, milk, other dairy, fish, fruits/vegetables, grain, beef, pork, poultry, vegetable oils and condiments (Schecter. 2013)
I wonder which science says that the foods babies eat should contain 4.3x more phthalates (on a per kg body weight basis), than the junk adults are eating.
Several studies have reported an increased risk of allergic disease among children with higher childhood phthalate exposure, as well as increased airway inflammation.
Some human studies suggest that in-utero phthalate exposure could lead to abnormal genital and behavioral development.
Based on our current understanding, diet and dust are the predominant sources of DEHP and BBzP, while cosmetics are the major source of DEP.
Ok, this is of course a result of the fact that babies weight less than adults do, but it is also a consequence of the fact that the baby foods are freaking "plasticized" - regardless of whether you buy them in glass or plastic containers. A fruit homogenate sold in glass bottles for example contained 235ng/g DEHP (about as much as paper-packaged butter, by the way) and was topped only by plastic food such as ham (1158ng/g). Again, way below the amount of DEHP that's deemed to be toxic, but is it really coincidence that a group of scientists from the University of Washington and the Havard Medical School only recently published an opinion paper (Braun. 2013), in which they formulate the take home messages I quote in the red box to the right... just food for thought, of course!
I guess you know what's next!? Correct: "That's it for today! Check out the facebook news, such as
Wolverine doesn't care about the phthalates in milk, but what about homogenization? (read more) could be the only face of the "Got Milk" campaign who does not have to care about potential negative health effects of homogenized milk.
Thyroglobulin levels could be a measure of adequate iodine intake -- Both, too high and too low iodine intakes will result in increased thyroglobolin levels (read more)
Dairy & blood pressure - revisited & acquitted -- "[....]the preponderance of evidence indicates dairy foods are beneficially associated with blood pressure" (read more)
Supplement users are a special kind of people -- Specifically health conscious, for example, and this will necessarily distort all epidemiological guesswork like "taking supplement X is associated with Y" (read more)
Retinoic acid & testosterone: While vitamin A does not figure in the LH induced increase in testosterone production it's presence in the testes appears to be necessary to keep the basal testosterone production up (read more)
if you still can't get enough of the latest on exercise, nutrition and supplementation science and have a nice Saturday evening (+ night)!"
References:
Braun JM, Sathyanarayana S, Hauser R. Phthalate exposure and children's health. Curr Opin Pediatr. 2013 Feb 16.
Dennison BA, Rockwell HL, Baker SL. Excess fruit juice consumption by preschool-aged children is associated with short stature and obesity. Pediatrics. 1997 Jan;99(1):15-22.
Granados J, Gillum T, Hodges C, Kuennen M. 3-hydroxy-5alpha-androst-1-en-17-one Enhances Muscular Gains but Impairs the Cardio-metabolic Health of Resistance Trained Males. International Journal of Exercise Science. TACM 2013.
Just AC, Whyatt RM, Perzanowski MS, Calafat AM, Perera FP, Goldstein IF, Chen Q, Rundle AG, Miller RL. Prenatal exposure to butylbenzyl phthalate and early eczema in an urban cohort. Environ Health Perspect. 2012 Oct;120(10):1475-80. doi: 10.1289/ehp.1104544. Epub 2012 Jun 13.
Kamolrat T, Gray SR. The effect of eicosapentaenoic and docosahexaenoic acid on protein synthesis and breakdown in murine C2C12 myotubes. Biochem Biophys Res Commun. 2013 Feb 21.
Mammucari C, Milan G, Romanello V, Masiero E, Rudolf R, Del Piccolo P, Burden SJ, Di Lisi R, Sandri C, Zhao J, Goldberg AL, Schiaffino S, Sandri M. FoxO3 controls autophagy in skeletal muscle in vivo. Cell Metab. 2007 Dec;6(6):458-71.
McArthur SL. Infertility Fact Sheet. ABC Health & Well-Being. 2007 <http://www.abc.net.au/health/library/stories/2007/05/30/1919840.htm> retrieved March, 09, 2013.
Schecter A, Lorber M, Guo Y, Wu Q, Yun SH, Kannan K, Hommel M, Imran N, Hynan LS, Cheng D, Colacino JA, Birnbaum LS. Phthalate Concentrations and Dietary Exposure from Food Purchased in New York State. Environ Health Perspect. 2013 Mar 6.
Senf SM, Dodd SL, McClung JM, Judge AR. Hsp70 overexpression inhibits NF-kappaB and Foxo3a transcriptional activities and prevents skeletal muscle atrophy. FASEB J. 2008 Nov;22(11):3836-45.
Sundaram R, Naresh R, Shanthi P, Sachdanandam P. Modulatory effect of green tea extract on hepatic key enzymes of glucose metabolism in streptozotocin and high fat diet induced diabetic rats. Phytomedicine. 2013 Feb 27.
Tranfo G, Caporossi L, Paci E, Aragona C, Romanzi D, De Carolis C, De Rosa M, Capanna S, Papaleo B, Pera A. Urinary phthalate monoesters concentration in couples with infertility problems. Toxicol Lett. 2012 Aug 13;213(1):15-20.
White JP, Gao S, Puppa MJ, Sato S, Welle SL, Carson JA. Testosterone regulation of Akt/mTORC1/FoxO3a signaling in skeletal muscle. Mol Cell Endocrinol. 2013 Jan 30;365(2):174-86.
