When BMI Doesn’t Measure Up
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When BMI Doesn’t Quite Measure Up
Last month, we did a “Friday Mythbusters” edition of 10almonds, tackling many of the misconceptions surrounding obesity. Amongst them, we took a brief look at the usefulness (or lack thereof) of the Body Mass Index (BMI) scale of weight-related health for individuals. By popular subscriber request, we’re now going to dive a little deeper into that today!
The wrong tool for the job
BMI was developed as a tool to look at large-scale demographic trends, stemming from a population study of white European men, who were for the purpose of the study (the widescale health of the working class in that geographic area in that era), considered a reasonable default demographic.
In other words: as a system, it’s now being used in a way it was never made for, and the results of that misappropriation of an epidemiological tool for individual health are predictably unhelpful.
If you want to know yours…
Here’s the magic formula for calculating your BMI:
- Metric: divide your weight in kilograms by your height in square meters
- Imperial: divide your weight in pounds by your height in square inches and then multiply by 703
“What if my height doesn’t come in square meters or square inches, because it’s a height, not an area?”
We know. Take your height and square it anyway. If this seems convoluted and arbitrary, yes, it is.
But!
While on the one hand it’s convoluted and arbitrary… On the other hand, it’s also a gross oversimplification. So, yay for the worst of both worlds?
If you don’t want to grab a calculator, here’s a quick online tool to calculate it for you.
So, how did you score?
According to the CDC, a BMI score…
- Under 18.5 is underweight
- 18.5 to 24.9 is normal
- 25 to 29.9 is overweight
- 30 and over is obese
And, if we’re looking at a representative sample of the population, where the representation is average white European men of working age, that’s not a bad general rule of thumb.
For the rest of us, not so representative
BMI is a great and accurate tool as a rule of thumb, except for…
Women
An easily forgotten demographic, due to being a mere 51% of the world’s population, women generally have a higher percentage of body fat than men, and this throws out BMI’s usefulness.
If pregnant or nursing
A much higher body weight and body fat percentage—note that these are two things, not one. Some of the extra weight will be fat to nourish the baby; some will be water weight, and if pregnant, some will be the baby (or babies!). BMI neither knows nor cares about any of these things. And, this is a big deal, because BMI gets used by healthcare providers to judge health risks and guide medical advice.
People under the age of 16 or over the age of 65
Not only do people below and above those ages (respectively) tend to be shorter—which throws out the calculations and mean health risks may increase before the BMI qualifies as overweight—but also:
- BMI under 23 in people over the age of 65 is associated with a higher health risk
- A meta-analysis showed that a BMI of 27 was the best in terms of decreased mortality risk for the over-65 age group
This obviously flies in the face of conventional standards regards BMI—as you’ll recall from the BMI brackets we listed above.
Read the science: BMI and all-cause mortality in older adults: a meta-analysis
Athletic people
A demographic often described in scientific literature as “athletes”, but that can be misleading. When we say “athletes”, what comes to mind? Probably Olympians, or other professional sportspeople.
But also athletic, when it comes to body composition, are such people as fitness enthusiasts and manual laborers. Which makes for a lot more people affected by this!
Athletic people tend to have more lean muscle mass (muscle weighs more than fat), and heavier bones (can’t build strong muscles on weak bones, so the bones get stronger too, which means denser)… But that lean muscle mass can actually increase metabolism and help ward off many of the very same things that BMI is used as a risk indicator for (e.g. heart disease, and diabetes). So people in this category will actually be at lower risk, while (by BMI) getting told they are at higher risk.
If not white
Physical characteristics of race can vary by more than skin color, relevant considerations in this case include, for example:
- Black people, on average, not only have more lean muscle mass and less fat than white people, but also, have completely different risk factors for diseases such as diabetes.
- Asian people, on average, are shorter than white people, and as such may see increased health risks before BMI qualifies as overweight.
- Hispanic people, on average, again have different physical characteristics that throw out the results, in a manner that would need lower cutoffs to be even as “useful” as it is for white people.
Further reading on this: BMI and the BIPOC Community
In summary:
If you’re an average white European working-age man, BMI can sometimes be a useful general guide. If however you fall into one or more of the above categories, it is likely to be inaccurate at best, if not outright telling the opposite of the truth.
What’s more useful, then?
For heart disease risk and diabetes risk both, waist circumference is a much more universally reliable indicator. And since those two things tend to affect a lot of other health risks, it becomes an excellent starting point for being aware of many aspects of health.
Pregnancy will still throw off waist circumference a little (measure below the bump, not around it!), but it will nevertheless be more helpful than BMI even then, as it becomes necessary to just increase the numbers a little, according to gestational month and any confounding factors e.g. twins, triplets, etc. Ask your obstetrician about this, as it’s beyond the scope of today’s newsletter!
As to what’s considered a risk:
- Waist circumference of more than 35 inches for women
- Waist circumference of more than 40 inches for men
These numbers are considered applicable across demographics of age, sex, ethnicity, and lifestyle.
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Inverse Vaccines for Autoimmune Diseases
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Inverse Vaccines for Autoimmune Diseases
This is Dr. Jeffrey Hubbell. He’s a molecular engineer, with a focus on immunotherapy, immune response, autoimmune diseases, and growth factor variants.
He’s held 88 patents, and was the recipient of the Society for Biomaterials’ Founders Award for his “long-term, landmark contributions to the discipline of biomaterials”, amongst other awards and honours that would make our article too long if we included them all.
And, his latest research has been about developing…
Inverse Vaccines
You may be thinking: “you mean diseases; he’s engineering diseases?”
And no, it’s not that. Here’s how it works:
Normally in the case of vaccine, it’s something to tell the body “hey, if you see something that looks like this, you should kill it on sight” and the body goes “ok, preparing countermeasures according to these specifications; thanks for the heads-up”
In the case of an inverse vaccine, it’s the inverse. It’s something to tell the body “hey, this thing you seem to think is a threat, it’s actually not, and you should leave it alone”.
Why this matters for people with autoimmune diseases
Normally, autoimmune diseases are treated in one or more of the following ways:
- Dampen the entire immune system (bad for immunity against actual diseases, obviously, and is part of why many immunocompromised people have suffered and died disproportionately from COVID, for example)
- Give up and find a workaround (a good example of this is Type 1 Diabetes, and just giving up on the pancreas not being constantly at war with itself, and living on exogenous insulin instead)
Neither of those are great.
What inverse vaccines do is offer a way to flag the attacked-in-error items as acceptable things to have in the body. Those might be things that are in our body by default, as in the case of many autoimmune diseases, or they may even be external items that should be allowed but aren’t, as in the case of gluten, in the context of Celiac disease.
The latest research is not yet accessible for free, alas, but you can read the abstract here:
Or if you prefer a more accessible pop-science approach, here’s a great explanatory article:
“Inverse vaccine” shows potential to treat multiple sclerosis and other autoimmune diseases
Where can we get such inverse vaccines?
❝There are no clinically approved inverse vaccines yet, but we’re incredibly excited about moving this technology forward❞
~ Dr. Jeffrey Hubbell
But! Lest you be disappointed, you can get in line already, in the case of the Celiac disease inverse vaccine, if you’d like to be part of their clinical trial:
Click here to see if you are eligible to be part of their clinical trial
If you’re not up for that, or if your autoimmune disease is something else (most of the rest of their research is presently focusing on Multiple Sclerosis and Type 1 Diabetes), then:
- The phase 1 MS trial is currently active, estimated completion in summer 2024.
- They are in the process of submitting an investigational new drug (IND) application for Type 1 Diabetes
- This is the first step to starting clinical safety and efficacy trials
…so, watch this space!
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Atomic Habits – by James Clear
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James Clear’s Atomic Habits has become “the” go-to book about the power of habit-forming. And, there’s no shortage of competition out there, so that’s quite a statement. What makes this book stand out?
A lot of books start by assuming you want to build habits. That can seem a fair assumption; after all, we picked up the book! But an introductory chapter really hammers home the idea in a way that makes it a lot more motivational:
- Habits are the compound interest of productivity
- This means that progress is not linear, but exponential
- Habits can also be stacked, and thus become synergistic
- The more positive habits you add incrementally, the easier they become because each thing is making your life easier/better
For example:
- It’s easier to save money if you’re in good health
- It’s easier to sleep better if you do not have financial worries
- It’s easier to build your relationship with your loved ones if you’re not tired
…and so on.
For many people this presents a Catch-22 problem! Clear instead presents it as an opportunity… Start wherever you like, but just start small, with some two-minute thing, and build from there.
A lot of the book is given over to:
- how to form effective habits (using his “Four Laws”)
- how to build them into your life
- how to handle mishaps
- how to make sure your habits are working for you
- how to see habits as part of your identity, and not just a goal to be checked off
The last one is perhaps key—goals cease to be motivating once accomplished. Habits, on the other hand, keep spiralling upwards (if you guide them appropriately).
There’s lots more we could say, but it’s a one-minute book review, so we’ll just close by saying:
This book can help you to become the kind of person who genuinely gets a little better each day, and reaps the benefits over time.
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Healthy Longevity As A Lifestyle Choice
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7 Keys To Healthy Longevity
This is Dr. Luigi Fontana. He’s a research professor of Geriatrics & Nutritional Science, and co-director of the Longevity Research Program at Washington University in St. Louis.
What does he want us to know?
He has a many-fold approach to healthy longevity, most of which may not be news to you, but you might want to prioritize some things:
Consider caloric restriction with optimal nutrition (CRON)
This is about reducing the metabolic load on your body, which frees up bodily resources for keeping yourself young.
Keeping your body young and healthy is your body’s favorite thing to do, but it can’t do that if it never gets a chance because of all the urgent metabolic tasks you’re giving it.
If CRON isn’t your thing (isn’t practicable for you, causes undue suffering, etc) then intermittent fasting is a great CR mimetic, and he recommends that too. See also:
- Is Cutting Calories The Key To Healthy Long Life?
- Fasting Without Crashing? We Sort The Science From The Hype
Keep your waistline small
Whichever approach you prefer to use to look after your metabolic health, keeping your waistline down is much more important for health than BMI.
Specifically, he recommends keeping it:
- under 31.5” for women
- under 37” for men
The disparity here is because of hormonal differences that influence both metabolism and fat distribution.
Exercise as part of your lifestyle
For Dr. Fontana, he loves mountain-biking (this writer could never!) and weight-lifting (also not my thing). But what’s key is not the specifics, but what’s going on:
- Some kind of frequent movement
- Some kind of high-intensity interval training
- Some kind of resistance training
Frequent movement because our bodies are evolved to be moving more often than not:
The Doctor Who Wants Us To Exercise Less, & Move More
High-Intensity Interval Training because unlike most forms of exercise (which slow metabolism afterwards to compensate), it boosts metabolism for up to 2 hours after training:
How To Do HIIT (Without Wrecking Your Body)
Resistance training because strength (of muscles and bones) matters too:
Resistance Is Useful! (Especially As We Get Older)
Writer’s examples:
So while I don’t care for mountain-biking or weight-lifting, what I do is:
1) movement: walk (briskly!) everywhere and also use a standing desk
2) HIIT: 2-minute bursts of hindu squats and/or exercise bike sprints
3) resistance: pilates and other calisthenicsModeration is not key
Dr. Fontana advises that we do not smoke, and that we do not drink alcohol, for example. He also notes that just as the only healthy amount of alcohol is zero, less ultra-processed food is always better than more.
Maybe you don’t want to abstain completely, but mindful wilful consumption of something unhealthy is preferable to believing “moderate consumption is good for the health” and an unhealthy habit develops!
Greens and beans
Shocking absolutely nobody, Dr. Fontana advocates for (what has been the most evidence-based gold standard of healthy-aging diets for quite some years now) the Mediterranean diet.
See also: Four Ways To Upgrade The Mediterranean Diet ← this is about tweaking the Mediterranean diet per personal area of focus, e.g. anti-inflammatory bonus, best for gut, heart healthiest, and most neuroprotective.
Take it easy
Dr. Fontana advises us (again, with a wealth of evidence) Mindfulness-Based Stress Reduction, and to get good sleep.
Not shocked?
To quote the good doctor,
❝There are no shortcuts. No magic pills or expensive procedures can replace the beneficial effects of a healthy diet, exercise, mindfulness, or a regenerating night’s sleep.❞
Always a good reminder!
Want to know more?
You might enjoy his book “The Path to Longevity: How to Reach 100 with the Health and Stamina of a 40-Year-Old”, which we reviewed previously
You might also like this video of his, about changing the conversation from “chronic disease” to “chronic health”:
Want to watch it, but not right now? Bookmark it for later
Take care!
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Science of Stretch – by Dr. Leada Malek
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This book is part of a “Science of…” series, of which we’ve reviewed some others before (Yoga | HIIT | Pilates), and needless to say, we like them.
You may be wondering: is this just that thing where a brand releases the same content under multiple names to get more sales, and no, it’s not (long-time 10almonds readers will know: if it were, we’d say so!).
While flexibility and mobility are indeed key benefits in yoga and Pilates, they looked into the science of what was going on in yoga asanas and Pilates exercises, stretchy or otherwise, so the stretching element was not nearly so deep as in this book.
In this one, Dr. Malek takes us on a wonderful tour of (relevant) human anatomy and physiology, far deeper than most pop-science books go into when it comes to stretching, so that the reader can really understand every aspect of what’s going on in there.
This is important, because it means busting a lot of myths (instead of busting tendons and ligaments and things), understanding why certain things work and (critically!) why certain things don’t, how certain stretching practices will sabotage our progress, things like that.
It’s also beautifully clearly illustrated! The cover art is a fair representation of the illustrations inside.
Bottom line: if you want to get serious about stretching, this is a top-tier book and you won’t regret it.
Click here to check out Science of Stretching, and learn what you can do and how!
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Managing [E-word] Dysfunction Reactions
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It’s Q&A Day at 10almonds!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
We had several requests pertaining to veganism, meatless mondays, and substitutions in recipes—so we’re going to cover those on a different day!
As for questions we’re answering today…
Q: Information on [e-word] dysfunction for those who have negative reactions to [the most common medications]?
When it comes to that particular issue, one or more of these three factors are often involved:
- Hormones
- Circulation
- Psychology
The most common drugs (that we can’t name here) work on the circulation side of things—specifically, by increasing the localized blood pressure. The exact mechanism of this drug action is interesting, albeit beyond the scope of a quick answer here today. On the other hand, the way that they work can cause adverse blood-pressure-related side effects for some people; perhaps you’re one of them.
To take matters into your own hands, so to speak, you can address each of those three things we just mentioned:
Hormones
Ask your doctor (or a reputable phlebotomy service) for a hormone test. If your free/serum testosterone levels are low (which becomes increasingly common in men over the age of 45), they may prescribe something—such as testosterone shots—specifically for that.
This way, it treats the underlying cause, rather than offering a workaround like those common pills whose names we can’t mention here.
Circulation
Look after your heart health; eat for your heart health, and exercise regularly!
Cold showers/baths also work wonders for vascular tone—which is precisely what you need in this matter. By rapidly changing temperatures (such as by turning off the hot water for the last couple of minutes of your shower, or by plunging into a cold bath), your blood vessels will get practice at constricting and maintaining that constriction as necessary.
Psychology
[E-word] dysfunction can also have a psychological basis. Unfortunately, this can also then be self-reinforcing, if recalling previous difficulties causes you to get distracted/insecure and lose the moment. One of the best things you can do to get out of this catch-22 situation is to not worry about it in the moment. Depending on what you and your partner(s) like to do in bed, there are plenty of other equally respectable options, so just switch track!
Having a conversation about this in advance will probably be helpful, so that everyone’s on the same page of the script in that eventuality, and it becomes “no big deal”. Without that conversation, misunderstandings and insecurities could arise for your partner(s) as well as yourself (“aren’t I desirable enough?” etc).
So, to recap, we recommend:
- Have your hormones checked
- Look after your circulation
- Make the decision to have fun!
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Huperzine A: A Natural Nootropic
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Huperzine A: A Natural Nootropic
Huperzine A is a compound, specifically a naturally occurring sesquiterpene alkaloid, that functions as an acetylcholinesterase inhibitor. If that seems like a bunch of big words, don’t worry, we’ll translate in a moment.
First, a nod to its origins: it is found in certain kinds of firmoss, especially the “toothed clubmoss”, Huperzia serrata, which grows in many Asian countries.
What’s an acetylcholinesterase inhibitor?
Let’s do this step-by-step:
- An acetylcholinesterase inhibitor is a compound that inhibits acetylcholinesterase.
- Acetylcholinesterase is an enzyme that catalyzes (speeds up) the breakdown of acetylcholine.
- Acetylcholine is a neurotransmitter; it’s an ester of acetic acid and choline.
- This is the main neurotransmitter of the parasympathetic nervous system, and is also heavily involved in cognitive functions including memory and creative thinking.
What this means: if you take an acetylcholinesterase inhibitor like huperzine A, it will inhibit acetylcholinesterase, meaning you will have more acetylcholine to work with. That’s good.
What can I expect from it?
Huperzine A has been well-studied for a while, mostly for the prevention and treatment of Alzheimer’s disease:
- New insights into huperzine A for the treatment of Alzheimer’s disease
- Huperzine A: Is it an Effective Disease-Modifying Drug for Alzheimer’s Disease?
- Huperzine A and Its Neuroprotective Molecular Signaling in Alzheimer’s Disease
However, research has suggested that huperzine A is much better as a prevention than a treatment:
❝A central event in the pathogenesis of Alzheimer’s disease (AD) is the accumulation of senile plaques composed of aggregated amyloid-β (Aβ) peptides.
Ex vivo electrophysiological experiments showed that 10 μM of Aβ1-40 significantly decreased the effect of the AChE inhibitor huperzine A on the synaptic potential parameters. ❞
~ Dr. Irina Zueva
In other words: the answer to the titular question is “Yes, yes it can”
And, to translate Dr. Zueva’s words into simple English:
- People with Alzheimer’s have amyloid-β plaque in their brains
- That plaque reduces the effectiveness of huperzine A
So, what if we take it in advance? That works much better:
❝Pre-treatment with [huperzine A] at concentrations of 50, 100, and 150 µg/mL completely inhibited the secretion of PGE2, TNF-α, IL-6, and IL-1β compared to post-treatment with [huperzine A].
This suggests that prophylactic treatment is better than post-inflammation treatment. ❞
~ Dr. Thu Kim Dang
Source: Anti-neuroinflammatory effects of alkaloid-enriched extract from Huperzia serrata
As you may know, neuroinflammation is a big part of Alzheimer’s pathology, so we want to keep that down. The above research suggests we should do that sooner rather than later.
Aside from holding off dementia, can it improve memory now, too?
There’s been a lot less research done into this (medicine is generally more concerned with preventing/treating disease, than improving the health of healthy people), but there is some:
^This is a small (n=68) old (1999) study for which the full paper has mysteriously disappeared and we only get to see the abstract. It gave favorable results, though.
The effects of huperzine A and IDRA 21 on visual recognition memory in young macaques
^This, like most non-dementia research into HupA, is an animal study. But we chose to spotlight this one because, unlike most of the studies, it did not chemically lobotomize the animals first; they were and remained healthy. That said, huperzine A improved the memory scores most for the monkeys that performed worst without it initially.
Where can I get it?
As ever, we don’t sell it, but here’s an example product on Amazon for your convenience
Enjoy!
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