Good news: midlife health is about more than a waist measurement. Here’s why
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You’re not in your 20s or 30s anymore and you know regular health checks are important. So you go to your GP. During the appointment they measure your waist. They might also check your weight. Looking concerned, they recommend some lifestyle changes.
GPs and health professionals commonly measure waist circumference as a vital sign for health. This is a better indicator than body mass index (BMI) of the amount of intra-abdominal fat. This is the really risky fat around and within the organs that can drive heart disease and metabolic disorders such as type 2 diabetes.
Men are at greatly increased risk of health issues if their waist circumference is greater than 102 centimetres. Women are considered to be at greater risk with a waist circumference of 88 centimetres or more. More than two-thirds of Australian adults have waist measurements that put them at an increased risk of disease. An even better indicator is waist circumference divided by height or waist-to-height ratio.
But we know people (especially women) have a propensity to gain weight around their middle during midlife, which can be very hard to control. Are they doomed to ill health? It turns out that, although such measurements are important, they are not the whole story when it comes to your risk of disease and death.
How much is too much?
Having a waist circumference to height ratio larger than 0.5 is associated with greater risk of chronic disease as well as premature death and this applies in adults of any age. A healthy waist-to-height ratio is between 0.4 to 0.49. A ratio of 0.6 or more places a person at the highest risk of disease.
Some experts recommend waist circumference be routinely measured in patients during health appointments. This can kick off a discussion about their risk of chronic diseases and how they might address this.
Excessive body fat and the associated health problems manifest more strongly during midlife. A range of social, personal and physiological factors come together to make it more difficult to control waist circumference as we age. Metabolism tends to slow down mainly due to decreasing muscle mass because people do less vigorous physical activity, in particular resistance exercise.
For women, hormone levels begin changing in mid-life and this also stimulates increased fat levels particularly around the abdomen. At the same time, this life phase (often involving job responsibilities, parenting and caring for ageing parents) is when elevated stress can lead to increased cortisol which causes fat gain in the abdominal region.
Midlife can also bring poorer sleep patterns. These contribute to fat gain with disruption to the hormones that control appetite.
Finally, your family history and genetics can make you predisposed to gaining more abdominal fat.
Why the waist?
This intra-abdominal or visceral fat is much more metabolically active (it has a greater impact on body organs and systems) than the fat under the skin (subcutaneous fat).
Visceral fat surrounds and infiltrates major organs such as the liver, pancreas and intestines, releasing a variety of chemicals (hormones, inflammatory signals, and fatty acids). These affect inflammation, lipid metabolism, cholesterol levels and insulin resistance, contributing to the development of chronic illnesses.
The issue is particularly evident during menopause. In addition to the direct effects of hormone changes, declining levels of oestrogen change brain function, mood and motivation. These psychological alterations can result in reduced physical activity and increased eating – often of comfort foods high in sugar and fat.
But these outcomes are not inevitable. Diet, exercise and managing mental health can limit visceral fat gains in mid-life. And importantly, the waist circumference (and ratio to height) is just one measure of human health. There are so many other aspects of body composition, exercise and diet. These can have much larger influence on a person’s health.
Muscle matters
The quantity and quality of skeletal muscle (attached to bones to produce movement) a person has makes a big difference to their heart, lung, metabolic, immune, neurological and mental health as well as their physical function.
On current evidence, it is equally or more important for health and longevity to have higher muscle mass and better cardiorespiratory (aerobic) fitness than waist circumference within the healthy range.
So, if a person does have an excessive waist circumference, but they are also sedentary and have less muscle mass and aerobic fitness, then the recommendation would be to focus on an appropriate exercise program. The fitness deficits should be addressed as priority rather than worry about fat loss.
Conversely, a person with low visceral fat levels is not necessarily fit and healthy and may have quite poor aerobic fitness, muscle mass, and strength. The research evidence is that these vital signs of health – how strong a person is, the quality of their diet and how well their heart, circulation and lungs are working – are more predictive of risk of disease and death than how thin or fat a person is.
For example, a 2017 Dutch study followed overweight and obese people for 15 years and found people who were very physically active had no increased heart disease risk than “normal weight” participants.
Getting moving is important advice
Physical activity has many benefits. Exercise can counter a lot of the negative behavioural and physiological changes that are occurring during midlife including for people going through menopause.
And regular exercise reduces the tendency to use food and drink to help manage what can be a quite difficult time in life.
Measuring your waist circumference and monitoring your weight remains important. If the measures exceed the values listed above, then it is certainly a good idea to make some changes. Exercise is effective for fat loss and in particular decreasing visceral fat with greater effectiveness when combined with dietary restriction of energy intake. Importantly, any fat loss program – whether through drugs, diet or surgery – is also a muscle loss program unless resistance exercise is part of the program. Talking about your overall health with a doctor is a great place to start.
Accredited exercise physiologists and accredited practising dietitians are the most appropriate allied health professionals to assess your physical structure, fitness and diet and work with you to get a plan in place to improve your health, fitness and reduce your current and future health risks.
Rob Newton, Professor of Exercise Medicine, Edith Cowan University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Why You Can’t Skimp On Amino Acids
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Our body requires 20 amino acids (the building blocks of protein), 9 of which it can’t synthesize (thus called: “essential”) and absolutely must get from food. Normally, we get these amino acids from protein in our diet, and we can also supplement them by taking amino acid supplements if we wish.
Specifically, we require (per kg of bodyweight) a daily average of:
- Histidine: 10 mg
- Isoleucine: 20 mg
- Leucine: 39 mg
- Lysine: 30 mg
- Methionine: 10.4 mg
- Phenylalanine*: 25 mg
- Threonine: 15 mg
- Tryptophan: 4 mg
- Valine: 26 mg
*combined with the non-essential amino acid tyrosine
Source: Protein and Amino Acid Requirements In Human Nutrition: WHO Technical Report
Why this matters
A lot of attention is given to protein, and making sure we get enough of it, especially as we get older, because the risk of sarcopenia (muscle mass loss) increases with age:
However, not every protein comes with a complete set of essential amino acids, and/or have only trace amounts of of some amino acids, meaning that a dietary deficiency can arrive if one’s diet is too restrictive.
And, if we become deficient in even just one amino acid, then bad things start to happen quite soon. We only have so much space, so we’re going to oversimplify here, but:
- Histidine: is needed to produce histamine (vital for immune responses, amongst other things), and is also important for maintaining the myelin sheaths on nerve cells.
- Isoleucine: is very involved in muscle metabolism and makes up the bulk of muscle tissue.
- Leucine: is critical for muscle synthesis and repair, as well as wound healing in general, and blood sugar regulation.
- Lysine: is also critical in muscle synthesis, as well as calcium absorption and hormone production, as well as making collagen.
- Methionine: is very important for energy metabolism, zinc absorption, and detoxification.
- Phenylalanine: is a necessary building block of a lot of neurotransmitters, as well as being a building block of some amino acids not listed here (i.e., the ones your body synthesizes, but can’t without phenylalanine).
- Threonine: is mostly about collagen and elastin production, and is also very important for your joints, as well as fat metabolism.
- Tryptophan: is the body’s primary precursor to serotonin, so good luck making the latter without the former.
- Valine: is mostly about muscle growth and regeneration.
So there you see, the ill effects of deficiency can range from “muscle atrophy” to “brain stops working” and “bones fall apart” and more. In short, any essential amino acid deficiency not remedied will ultimately result in death; we literally become non-viable as organisms without these 9 things.
What to do about it (the “life hack” part)
Firstly, if you eat a lot of animal products, those are “complete” proteins, meaning that they contain all 9 essential amino acids in sensible quantities. The reason that all animal products have these, is because they are just as essential for the other animals as they are for us, so they, just like us, must consume (and thus contain) them.
However, a lot of animal products come with other health risks:
Do We Need Animal Products To Be Healthy? ← this covers which animal products are definitely very health-risky, and which are probably fine according to current best science
…so many people may prefer to get more (or possibly all) dietary protein from plants.
However, plants, unlike us, do not need to consume all 9 essential amino acids, and this may or may not contain them all.
Soy is famously a “complete” protein insofar as it has all the amino acids we need.
But what if you’re allergic to soy?
Good news! Peas are also a “complete” protein and will do the job just fine. They’re also usually cheaper.
Final note
An oft-forgotten thing is that some other amino acids are “conditionally essential”, meaning that while we can technically synthesize them, sometimes we can’t synthesize enough and must get them from our diet.
The conditions that trigger this “conditionally essential” status are usually such things as fighting a serious illness, recovering from a serious injury, or pregnancy—basically, things where your body has to work at 110% efficiency if it wants to get through it in one piece, and that extra 10% has to come from somewhere outside the body.
Examples of commonly conditionally essential amino acids are arginine and glycine.
Arginine is critical for a lot of cell-signalling processes as well as mitochondrial function, as well as being a precursor to other amino acids, including creatine.
As for glycine?
Check out: The Sweet Truth About Glycine
Enjoy!
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The Inflamed Mind – by Dr. Edward Bullmore
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Firstly, let’s note that this book was published in 2018, so the “radical new” approach is more like “tried and tested and validated” now.
Of course, inflammation in the brain is also linked to Alzheimer’s, Parkinson’s, and other neurodegenerative disorders, but that’s not the main topic here.
Dr. Bullmore, a medical doctor, psychiatrist, and neuroscientist with half the alphabet after his name, knows his stuff. We don’t usually include author bio information here, but it’s also relevant that he has published more than 500 scientific papers and is one of the most highly cited scientists worldwide in neuroscience and psychiatry.
What he explores in this book, with a lot of hard science made clear for the lay reader, is the mechanisms of action of depression treatments that aren’t just SSRIs, and why anti-inflammatory approaches can work for people with “treatment-resistant depression”.
The book was also quite prescient in its various declarations of things he expects to happen in the field in the next five years, because they’ve happened now, five years later.
Bottom line: if you’d like to understand how the mind and body affect each other in the cases of inflammation and depression, with a view to lessening either or both of those things, this is a book for you.
Click here to check out The Inflamed Mind, and take good care of yours!
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How Not to Age – by Dr. Michael Greger
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First things first: it’s a great book, and it’s this reviewer’s favorite of Dr. Greger’s so far (for posterity: it’s just been published and this reviewer has just finished reading the copy she got on pre-order)
Unlike many popular physician authors, Dr. Greger doesn’t rehash a lot of old material, and instead favours prioritizing new material in each work. Where appropriate, he’ll send the reader to other books for more specific information (e.g: you want to know how to avoid premature death? Go read How Not To Die. You want to know how to lose weight? How Not To Diet. Etc).
In the category of new information, he has a lot to offer here. And with over 8,000 references, it’s information, not conjecture. On which note, we recommend the e-book version if that’s possible for you, for three reasons:
- It’s possible to just click the references and be taken straight to the cited paper itself online
- To try to keep the book’s size down, Dr. Greger has linked to other external resources too
- The only negative reviews on Amazon, so far, are people complaining that the print copy’s text is smaller than they’d like
For all its information-density (those 8,000+ references are packed into 600ish pages), the book is very readable even to a lay reader; the author is a very skilled writer.
As for the content, we can’t fit more than a few sentences here so forgive the brevity, but we’ll mention that he covers:
- Slowing 11 pathways of aging
- The optimal anti-aging regimen according to current best science
- Preserving function (specific individual aspects of aging, e.g. hearing, sight, cognitive function, sexual function, hair, bones, etc)
- “Dr. Greger’s Anti-Aging Eight”
In terms of “flavor” of anti-aging science, his approach can be summed up as: diet and lifestyle as foundation; specific supplements and interventions as cornerstones.
Bottom line: this is now the anti-aging book.
Click here to check out How Not To Age, and look after yourself with the best modern science!
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The Couple’s Guide to Thriving with ADHD – by Melissa Orlov and Nancie Kohlenberger
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ADHD (what a misleadingly-named condition) is most often undiagnosed in adults, especially older adults, and has far-reaching effects. This book explores those!
Oftentimes ADHD is not a deficit of attention, it’s just a lack of choice about where one’s attention goes. And the H? It’s mostly not what people think it is. The diagnostic criteria have moved far beyond the original name.
But in a marriage, ADHD symptoms such as wandering attention, forgetfulness, impulsiveness, and a focus on the “now” to the point of losing sight of the big picture (the forgotten past and the unplanned future), can cause conflict.
The authors write in a way that is intended for the ADHD and/or non-ADHD partner to read, and ideally, for both to read.
They shine light on why people with or without ADHD tend towards (or away from) certain behaviours, what miscommunications can arise, and how to smooth them over.
Best of all, an integrated plan for getting you both on the same page, so that you can tackle anything that arises, as the diverse team (with quite different individual strengths) that you are.
Bottom line: if you or a loved one has ADHD symptoms, this book can help you navigate and untangle what can otherwise sometimes get a little messy.
Click here to check out The Couple’s Guide to Thriving with ADHD, and learn how to do just that!
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HRT Side Effects & Troubleshooting
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This is Dr. Heather Hirsch. She’s a board-certified internist, and her clinical expertise focuses on women’s health, particularly in midlife and menopause, and its intersection with chronic diseases (ranging from things associated with sexual health, to things like osteoporosis and heart disease).
So, what does she want us to know?
HRT can be life-changingly positive, but it can be a shaky start
Hormone Replacement Therapy (HRT), and in this context she’s talking specifically about the most common kind, Menopausal Hormone Therapy (MHT), involves taking hormones that our body isn’t producing enough of.
If these are “bioidentical hormones” as used in most of the industrialized world and increasingly also in N. America, then this is by definition a supplement rather than a drug, for what it’s worth, whereas some non-bioidentical hormones (or hormone analogs, which by definition function similarly to hormones but aren’t the same thing) can function more like drugs.
We wrote a little about his previously:
Hormone Replacement Therapy: A Tale Of Two Approaches
For most people most of the time, bioidentical hormones are very much the best way to go, as they are not only more effective, but also have fewer side effects.
That said, even bioidentical hormones can have some undesired effects, so, how to deal with those?
Don’t worry; bleed happy
A reprise of (usually quite light) menstrual bleeding is the most common side effect of menopausal HRT.
This happens because estrogen affects* the uterus, leading to a build-up and shedding of the uterine lining.
*if you do not have a uterus, estrogen can effect uterine tissue. That’s not a typo—here we mean the verb “effect”, as in “cause to be”. It will not grow a new uterus, but it can cause some clumps of uterine tissue to appear; this means that it becomes possible to get endometriosis without having a uterus. This information should not be too shocking, as endometriosis is a matter of uterine tissue growing inconveniently, often in places where it shouldn’t, and sometimes quite far from the uterus (if present, or its usual location, if absent). However, the risk of this happening is far lower than if you actually have a uterus:
What you need to know about endometriosis
Back to “you have a uterus and it’s making you wish you didn’t”:
This bleeding should, however, be light. It’ll probably be oriented around a 28-day cycle even if you are taking your hormones at the same dose every day of the month, and the bleeding will probably taper off after about 6 months of this.
If the bleeding is heavier, all the time, or persists longer than 6 months, then speak to your gynecologist about it. Any of those three; it doesn’t have to be all three!
Bleeding outside of one’s normal cycle can be caused by anything from fibroids to cancer; statistically speaking it’s probably nothing too dire,but when your safety is in question, don’t bet on “probably”, and do get it checked out:
When A Period Is Very Late (i.e., Post-Menopause)
Dr. Hirsch recommends, as possible remedies to try (preferably under your gynecologist’s supervision):
- lowering your estrogen dose
- increasing your progesterone dose
- taking progesterone continuously instead of cyclically
And if you’re not taking progesterone, here’s why you might want to consider taking this important hormone that works with estrogen to do good things, and against estrogen to rein in some of estrogen’s less convenient things:
Progesterone Menopausal HRT: When, Why, And How To Benefit
(the above link contains, as well as textual information, an explanatory video from Dr. Hirsch herself)
Get the best of the breast
Calm your tits. Soothe your boobs. Destress your breasts. Hakuna your tatas. Undo the calamity beleaguering your mammaries.
Ok, more seriously…
Breast tenderness is another very common symptom when starting to take estrogen. It can worry a lot of people (à la “aagh, what is this and is it cancer!?”), but is usually nothing to worry about. But just to be sure, do also check out:
Keeping Abreast Of Your Cancer Risk: How To Triple Your Breast Cancer Survival Chances
Estrogen can cause feelings of breast fullness, soreness, nipple irritation, and sometimes lactation, but this later will be minimal—we’re talking a drop or two now and again, not anything that would feed a baby.
Basically, it happens when your body hasn’t been so accustomed to normal estrogen levels in a while, and suddenly wakes up with a jolt, saying to itself “Wait what are we doing puberty again now? I thought we did menopause? Are we pregnant? What’s going on? Ok, checking all systems!” and then may calm down not too long afterwards when it notes that everything is more or less as it should be already.
If this persists or is more than a minor inconvenience though, Dr. Hirsch recommends looking at the likely remedies of:
- Adjust estrogen (usually the cause)
- Adjust progesterone (less common)
- If it’s progesterone, changing the route of administration can ameliorate things
What if it’s not working? Is it just me?
Dr. Hirsch advises the most common reasons are simply:
- wrong formulation (e.g. animal-derived estrogen or hormone analog, instead of bioidentical)
- wrong dose (e.g. too low)
- wrong route of administration (e.g. oral vs transdermal; usually transdermal estradiol is most effective but many people do fine on oral; progesterone meanwhile is usually best as a pessary/suppository, but many people do fine on oral)
Writer’s example: in 2022 there was an estrogen shortage in my country, and while I had been on transdermal estradiol hemihydrate gel, I had to go onto oral estradiol valerate tablets for a few months, because that’s what was available. And the tablets simply did not work for me at all. I felt terrible and I have a good enough intuitive sense of my hormones to know when “something wrong is not right”, and a good enough knowledge of the pharmacology & physiology to know what’s probably happening (or not happening). And sure enough, when I got my blood test results, it was as though I’d been taking nothing. It was such a relief to get back on the gel once it became available again!
So, if something doesn’t seem to be working for you, speak up and get it fixed if at all possible.
See also: What You Should Have Been Told About Menopause Beforehand
Want to know more from Dr. Hirsch?
You might like this book of hers, which we haven’t reviewed yet, but present here for your interest:
Enjoy!
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Understanding Cellulitis: Skin And Soft Tissue Infections
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What’s the difference between a minor passing skin complaint, and a skin condition that’s indicative of something more serious? Dr. Thomas Watchman explains:
More than skin-deep
Cellulitis sounds benign enough, like having a little cellulite perhaps, but in fact it means an infection of the skin and—critically—the underlying soft tissues.
Normally, the skin acts as a barrier against infections, but this barrier can be breached by physical trauma (i.e. an injury that broke the skin), eczema, fungal nail infections, skin ulcers, and other similar things that disrupt the skin’s ability to protect us.
Things to watch out for: Dr. Watchman advises we keep an eye out for warm, reddened skin, swelling, and blisters. Specifically, a golden-yellow crust to these likely indicates a Staphylococcus aureus infection (hence the name).
There’s a scale of degrees of severity:
- Class 1: No systemic toxicity or comorbidities
- Class 2: Systemic toxicity or comorbidities present
- Class 3: Significant systemic toxicity or comorbidities with risk of significant deterioration
- Class 4: Sepsis or life-threatening infection
…with antibiotics being recommended in the latter two cases there, or in other cases for frail, young, old, or immunocompromised patients. Given the rather “scorched earth” results of antibiotics (they cause a lot of collateral iatrogenic damage), this can be taken as a sign of how seriously such infections should be taken.
For more about all this, including visual guides, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
- Of Brains & Breakouts: The Brain-Skin Doctor
- Beyond Supplements: The Real Immune-Boosters!
- Antibiotics? You Might Want To Think Thrice
Take care!
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