Modern medicine tends to compartmentalize each illness. A typical patient might, for example, be diagnosed separately and at different times with high blood pressure, arthritis, gout, and depression. But increasingly, it is becoming clear that many of these diseases are in fact all downstream of the same few root causes, namely visceral fat, insulin resistance, and systemic inflammation. And while genetics do play an important role in our health (some people for example just never seem to develop diabetes no matter how poorly they eat or how obese they get; others do become diabetic after just a modest weight gain), lifestyle is by far the biggest driver of these issues.
So rather than viewing a patient as having several different chronic illnesses, it is more accurate to look for root causes, and understand that things like high blood pressure, high blood sugar, arthritis, and so forth are in turn downstream of those. Fix the root causes, and all of the other issues get better.
Here’s a quick review of an older study (from 1997). In the study, they took middle-aged diabetics and randomized them to do either nothing, or to do 45 minutes of vigorous cycling on a stationary bike twice per week, plus one session of high-intensity interval cardio training (consisting of two minutes of vigorous exercise followed by three minutes of light exercise for five cycles, for a total of 25 minutes).
After two months, the people who did the exercise had lost 48% of their visceral fat, and significantly improved their insulin sensitivity and blood glucose numbers, even though they didn’t lose a significant amount of weight overall. You can read the full study by clicking here.
Last year, I provided a link on this blog to a lecture I gave in 2023, about how lifestyle changes can improve arthritis and other musculoskeletal pains. If for some reason you want to watch that lecture, I will link to it here.
But to give you the brief summary of what I covered in that talk: being overweight doesn’t just cause arthritis by increasing physical pressure on the joint, but also because fat cells have the effect of up-regulating inflammatory signals in the body, which in turn lead to weakening of muscle, increased pain receptors, and other factors that create more pain.
Now a new study published in JAMA supports this point.
I’ve blogged on many occasions about my frustration with our national response to type 2 diabetes. While type 2 diabetes can be dramatically improved, and often outright cured, with lifestyle interventions such as diet and exercise, our system instead treats it as an intractable chronic illness that can merely be managed, not banished. Millions of patients are immediately put on medication at the first sign of poor blood sugar control, and while they are typically given some lip service about eating more healthfully, exercising, and losing weight, the focus of their treatment over the ensuing years involves an ever expanding pharmacopeia of medications. There is certainly evidence that many of these medications do help when compared to doing nothing, but it’s clear that even well treated diabetics don’t live as long and full lives as non-diabetics. So to me, this medication-centered approach is a tragedy of epic proportions.
Last year, I blogged in two separate posts about research into the topic of heart health and the keto diet. Now a follow-up study on this research has been published which sheds some important light on the topic.
Before getting into this new research, it would be worth your time to read (or re-read) my two prior posts on this topic, which can be found by clicking here and by clicking here.
One of the concepts I spend a lot of time talking to my patients about is the importance of maintaining muscle health. The reason for this is that virtually all people start to gradually lose muscle beginning somewhere in their 30s or 40s. At first these changes are barely noticeable, but by the time they are in their 70s many people will experience a huge degradation in their degree of fitness.
