#122 How to Lose 10 Pounds with Water Preloading

September 12th, 2015 by

How to Lose 10 Pounds with Water Preloading

“I just can’t seem to lose any weight,” Holly said at her last cardiology clinic visit.

“Are you drinking enough water?” I asked.

“I’m lucky if I can drink a glass or two of water through the day,” she replied.

Could water preloading be the secret for Holly to overcome her weight loss challenge?  In this article I share the new science behind water preloading and how it can help you to maintain a healthy weight for your heart.

What is Water Preloading?

Water preloading is really just the process of hydrating prior to every meal. Water preloading may help with weight loss because it stretches the stomach.  This mechanical stretching of the stomach shuts down ghrelin release.  With the hunger hormone ghrelin suppressed you will be less likely to overeat with your meal.

What is the Science Behind Water Preloading?

While many people have intuitively known that hydrating before a meal helps them to control their appetite, until recently there were no solid scientific data supporting this practice.  Fortunately, the study has now been done.  In this well-designed scientific study, Dr. Helen Parretti and colleagues from University of Birmingham showed effortless and significant weight loss with the simple act of water preloading.

To come to this conclusion, researchers enrolled 84 obese people and then randomly divided them into two groups.  The water preloading group was told to drink 500 mL, or 2 cups of water, within 30 minutes prior to eating each meal.  In contrast, the control group was told to imagine that their stomach was full prior to eating.  Interestingly, these study participants had no idea why they were doing what they were told to do.

Without even trying to lose weight, the water preloading group had lost an average of 5.3 pounds (2.4 kg) whereas the imagine your stomach is full group lost a mere 2.6 pounds (1.2 kg).  The results are even more impressive if you just look at the results of the people who actually did what they were supposed to do in this study.  Specifically, those who were 100% faithful in water preloading before each meal lost 9.5 pounds (4.3 kg)!  Equally impressive was that 27% of the water preloading group were able to lose enough weight to get down to their target body weight from water preloading alone.

Thin People Drink More Water

A separate line of evidence in support of water preloading is that there have now been many studies which have shown that fit people tend to drink more water.  Indeed, one study showed that water drinkers, on average, consumed 194 less calories each day.

It is unclear as to why fit people drink more water.  It is possible that by drinking water they are not drinking sugary or diet drinks.  Alternatively, drinking water may be allowing them to control their appetites.  Equally possible is that fit people drink water for cultural reasons as that is what healthy people tend to do.

Should You Try Water Preloading?

Given than about half of all Americans drink less than 4 cups of water each day, the simple answer would be “yes,” for most people.  Interestingly, in this report from the CDC, the same people who don’t drink enough water are also the same people who choose unhealthy foods.

The water preloading protocol of this study resulted in just 6 cups of water in a day.  This is still less than the 8 cups of water recommended by many healthcare providers.

For 99% of the population, there is little downside in drinking 2 cups of water before each meal.  Even if you don’t lose weight, if you are like most water deprived Americans, then drinking more water will probably result in other health benefits.

Will water preloading work for everyone?  Probably not.  However, if the results of this small study are true, then water preloading could result in a quick 10 pound weight loss over the next 3 months for you.

I must confess that since reviewing this study I have been very diligent in water preloading before each meal.  Whether it is a placebo effect or not, I have noticed that I don’t need to eat as much food to feel full.  Placebo effect or not, it is nice not feeling as hungry through certain parts of the day.

Who Shouldn’t Do Water Preloading?

If you are considering water preloading, and you do not feel well or are being treated for any medical condition, you should speak with your physician first.  For example, 500 mL of water prior to each meal is enough fluid to cause someone with heart failure to quickly become short of breath from fluid retention.

What has been your experience with water preloading?  Please leave your comments below for our community.

#083 How to Maintain a Healthy Weight

March 13th, 2015 by

How to Maintain a Healthy Weight

All her life Mary struggled to maintain a healthy weight.  She had spent thousands of dollars on all of the diets and programs.  When I saw her in my cardiology clinic she even described herself as the “poster child for the yo-yo dieter.”

Half of all Americans are worried about their weight.  Unfortunately, the deck is stacked against these people as studies have shown that up to 98% of dieters will regain all of their weight in just 2 years.

We all know people who have beaten the odds.  These “outliers” have somehow lost the weight and kept it off.  What secrets can we learn from these outliers that will help us to maintain a healthy weight?

10,000 People Who Lost 66 Pounds and Kept it off for 5 Years

In 1994 researchers Rena Wing from Brown University and James O. Hill from the University of Colorado were convinced that there had to be more people who had successfully lost and maintained their weight loss.  TFemale feet on bathroom scale with question mark symbolhey also wanted to understand what were the most important factors to successfully maintaining a healthy weight.

This collaboration led to the formation of the National Weight Loss Registry.  They advertised widely and have now collected a group of 10,000 people who have lost an average of 66 pounds and have successfully kept that weight off for 5.5 years. From these 10,000+ outliers they have published many scientific studies.

The key message from the National Weight Loss Registry is that successfully keeping weight off is very possible.  With a few simple techniques we can all maintain a healthy weight!

Intentional Versus Unintentional Weight Loss

I should point out that in this article I am defining successful weight loss as intentional weight loss.  Often, people may experience significant unintentional weight loss.  If this occurs, physicians need to know immediately as this could be a sign of a significant hormonal or metabolic abnormality or even an undiagnosed cancer.

The Number 1 Factor in Maintaining a Healthy Weight

Study after study has shown that the secret to maintaining a healthy weight is to exercise about an hour a day.  Data from the 10,000+ successful people in the National Weight Loss Registry also showed the same thing.  Of these 10,000+ people, 90% of them reported exercising an hour a day as their strategy to keep the 66 pounds off for more than 5 years.  The main exercise reported by these people was brisk walking.

IMG_8785I realize that in our hectic lives it can be very difficult to carve out an hour each day to exercise.  For me, this is why I use my treadmill and bike desks everyday (see photos).  This allows me to multitask so that I can both maintain a healthy weight and get my work done simultaneously.

Other ways to get in the hour of exercise while doing something else could be to bring a treadmill or stationary bike into your front room.  This can be a guilt free way to watch TV.

I also love a good book.  I have found that listening to books through Audible on my iPhone is a great way to “read” books and exercise at the same time.

If you are the type that does not have an hour to spare and would rather not exercise while doing something else, some studies report that high intensity exercise works just as well.  Thus, you could maintain your healthy weight by turning the intensity dial up.

Exercise: Weight Loss Versus Weight Maintenance

While exercise has been shown to be the number 1 factor in maintaining a healthy weight, I need to point out that exercise alone is rarely effective as a weight loss tool.  The reason is that to even burn 1 pound of fat (3,500 calories) it would require an enormous amount of exercise.

To put this into perspective let me give you an example.  If I ran a 4 hour marathon (26.2 miles) I would only burn 2,852 calories.  All of the effort in running a grueling marathon would not even burn 1 pound of body fat.

Thus, for weight loss eating the right foods in the right amounts is critical.  Once we get down to a healthy weight then exercise is critical to maintain the weight loss and avoid becoming part of that 98% that gains the weight right back.


In Mary’s case, her yo-yo dieting ended when she finally resolved to completely kick the sugar and processed food habit.  In addition to eliminating the sugar and processed foods it was also important for her to completely eliminate all simple carbs.  She made a simple rule that she would not eat anything that had a glycemic index of more than 50.

In addition to these simple dietary changes, she also committed to an hour of exercise each day.  This was the more challenging part for her as she had to change her daily routines and make some new friends to maintain this exercise habit.

These changes were made 3 years ago and she has not gained 1 of her 50 lost pounds back!  She is proof that it is not difficult to maintain weight loss.

The 5 Strategies of People Who Can Keep the Weight Off

There is much more we can learn from the 10,000+ success stories in the National Weight Loss Registry.  Here are the 5 main strategies used by these people.

1. Exercise

As mentioned, 90% of these successful dieters exercised about an hour a day to keep the weight off.  The main form of exercise reported was brisk walking.

2. Diet Changes

Fully 98% of the people in the National Weight Loss Registry reported that their diet had forever changed.  I have found that for many people, just getting rid of sugar and processed/prepared foods is all that is required to get down to a healthy weight.

3. Breakfast

Eating breakfast was reported as a successful weight maintenance strategy in 78% of the people. If you are not a breakfast person, you can still maintain a healthy weight as 22% of the people in the registry did not regularly eat breakfast.

4. Weigh Yourself Regularly

Weighing yourself at least once a week was reported as another key to success in 75% of the people in this registry.  While we can rationalize all we want about how we look, the scale doesn’t lie.  The scale can be a periodic “reality check” to make sure we are still on the right track.

5. Limit Your TV Time

Interestingly, 62% reported limiting their TV time to less than 10 hours per week as a successful strategy to maintaining a normal weight. To me, this means limiting the time you sit.  It is not just the TV but this would also apply to movies, surfing the internet, etc.

What strategies have worked well for you to maintain a healthy weight?  Do you agree with the 5 strategies reported by the 10,000+ successful people in the National Weight Loss Registry?


Please work under the direction of your physician if you are trying to lose or maintain a healthy weight.  They can help to guide you and monitor your progress to minimize the risk of any problems that might arise from your efforts.


#071 Do You Really Need 8 Glasses of Water Daily?

February 2nd, 2015 by

Do You Really Need 8 Glasses of Water Daily?

Your mother probably told you to drink 8 glasses of water each day. Many health “experts” also recommend getting at least 8 glasses (64 ounces or about 2 liters) of water each day.

Are you wondering if there’s actually any science backing up this advice?  Just how much water should we be drinking to lose weight and maintain optimal brain and heart function?

What the Science Tells Us about 8 Glasses of Water

You might be surprised to learn that there are actually no medical studies backing up the practice of drinking 8 glasses of water each day.  While there have been studies done on this subject, none of these studies to date have shown any significant benefit.

If there are no data supporting the medical need to drink 8 glasses of water each day then the question naturally arises, how much water should you drink?  The simple answer is, it depends.  In this article we will explore possible reasons why you may want to increase your water intake depending on your weight, brain, and heart goals.

How much water should you drink to stay hydrated?

It appears that the amount really depends on the individual person, where they live, and how active they are. Adults who live in an average climate and are moderately active can likely maintain their health drinking less than 8 glasses per day.  This doesn’t mean that you want to skimp on drinking your water however.

In contrast, those people who exercise frequently or live in very hot climates can lose up to 4 liters of fluid in just one hour of intense exercise on a hot day.  For these people, staying hydrated during a work out is critical for their health and to prevent a heat stroke.  These people could easily drink far more than 2 liters of water in a day.

Why is water so healthy?

Did you know that water makes up about 70% of your body?  Water helps to flush toxins from your bloodstream and cells, allowing your body to experience a daily “detox.”

Staying hydrated is also important for maintaining your energy, getting a good night’s sleep, and keeping your mood up.  If you want to appear young, water can also play an important role.  For example, if you are not drinking enough water, you may appear aged and can suffer from rough or cracked skin, bloating, or puffiness.

Can you really tell the difference between hunger and thirst?

Strangely, medical studies have shown us that we often cannot tell the difference between hunger and thirst. Unfortunately, most of us end up eating something when we really may just be thirsty.

Water helps us to feel full because it takes up a lot of volume in our stomachs.  Sometimes we may think we are hungry, and may even experience hunger pains, but in fact it may be that we are just experiencing mild dehydration.

When we don’t stay hydrated, we don’t feel the best that we could.  We tire easily, feel moody, get headaches, and we don’t function well overall. These uncomfortable feelings make us crave food because we are looking to food for more energy when all we really need is more water.

Water can help us to eat less at meal times as well. Try drinking 2 glasses of water right before you eat a meal and you may find you eat less since your stomach will feel partially full and you won’t be confusing thirst for hunger at all.

Why do water drinkers stay thin?

Have you ever noticed that people who carry a water bottle around with them seem to appear healthier and slimmer than most people?  What is the science behind water drinking and maintaining a healthy weight?

Besides not confusing hunger for thirst, the obvious answer is that if you are drinking a lot of water you probably are not drinking soda pop, fruit juice, or other sugary drinks.  This alone could cause significant weight loss.  I commonly see patients lose more than 20 pounds just by giving up all soda, fruit juice, sports drinks, and other sugary drinks.

Even diet soda may cause significant weight gain in many studies!  Studies show that even though you are not getting any “calories” from diet sodas, the aspartame in diet sodas is feeding your bad gut bacteria which, in turn, may cause weight gain.

Water also causes a significant calorie burn through the process of cold thermogenesis.  If you want to learn more about how to boost your metabolism through cold thermogenesis, I recently wrote an article on this subject (blog #68).

Studies have shown that by drinking 8 glasses (2 liters) of cold water, your body can be forced to burn an extra 400 calories!  Researchers report that most of this 400 calorie weight loss was due to the energy required by the body to heat the cold water up to body temperature.  If you do the math, drinking 2 liters per day of cold water, without increasing your food intake, would burn 42 extra pounds per year.

Since there is no risk in drinking more water for most people (see disclaimer at the bottom of this article), and you might even feel more energetic thereby increasing your work out routine, why not start drinking more water today?

Boost Cognition and Memory with Water

Could helping your child score well on the SAT or ACT college entrance tests be as simple as drinking more water?  Studies have consistently shown that children do better on tests when they are hydrated.  Even adults, based on medical studies, do better on cognition tests when they are well hydrated with water.

Other studies have shown that dehydration, or even relative mild dehydration like not drinking enough water during the day, can impair brain function.  Studies have even shown that fighter pilots don’t fly their planes as well if they are not drinking enough water.  Thus, if you want optimal brain and memory function learn to love water.

How much water should you drink to prevent heart disease?

If your goal is to prevent heart disease and never see a cardiologist, like me, then there are actually some data supporting how much water you should drink.

The Seventh Day Adventists are one of the healthiest groups of people in the world.  The Adventists have been extensively studied and have even been featured in the best selling health book, Blue Zones (affiliate link).

In this study, researchers closely followed 20,297 California Adventists for 6 years.  Interestingly, they found that those Adventists drinking 5 or more glasses of water each day were 54% less likely to die from heart disease!

Just how does water protect against a heart attack?  Could the benefit from water be because they drank water rather than soda pop, fruit juice, or other sugary drinks?  Likewise, could a high water intake be a manifestation of someone who is generally more health conscientious or someone who exercises a lot?

There are some studies that suggest that relative dehydration can cause you to have “thicker blood” or a higher blood viscosity.  If you are not drinking enough water then your blood particles are more likely to clump together and form clots.  These clots could lead to a heart attack or a stroke.  Regardless of how you can prevent a heart attack by drinking more water, it seems to me that drinking at least 5 glasses of water each day is a very healthy habit which we should adopt.

Dr. Day’s 6 Water Rules

To help you maintain a healthy weight and allow your brain and heart to function at its best, let my give you my six rules when it comes to drinking water.

1. Drink water instead of soda, fruit juice, or other sugary drinks

If you want to torpedo your health and your waist line, then drinking soda in either the high fructose corn syrup or diet varieties, juice, or other sugary drinks like sports drinks is a great strategy.  On the other hand, if you want to feel energized and maintain a healthy weight learn to love water.  If water isn’t yet your thing, try adding some fresh lemon or lime to your water.

2. If you are hungry between meals drink water first

Learn to notice the difference between your body’s true hunger signals, versus thirst signals. If you feel hungry between meals, try drinking something first. Wait 30 minutes. If you still feel hungry after 30 minutes, you probably are hungry and should eat something.

3. Drink water to boost your metabolism

To keep your body’s metabolism high, stay hydrated.  As discussed in this article, you can burn a significantly high amount of calories each day by drinking 2 liters of water.

4. Stay hydrated for optimal brain performance

Our brains require plenty of water to function optimally.  Stay hydrated to boost your cognition and memory.

5. Drink at least 5 glasses of water daily for your your heart

While 8 glasses of water (2 liters) has not been shown to make you “healthier,” there are data that drinking at least 5 glasses of water each day may protect your heart.  This may keep your blood viscosity low and prevent clots from forming.

6. Keep water with you throughout the day

As it is so easy for us to become dehydrated through the day, learn to carry a glass or stainless steel water bottle.  Having the water bottle with you is a great reminder to drink more.

How much water do you drink each day?  Do you carry a water bottle with you?


Please remember that if you suffer from heart failure, kidney failure, or other medical conditions you should discuss your optimal daily water intake first with your physician.

#068 How to Boost Metabolism: Cold Thermogenesis

January 26th, 2015 by

How to Boost Metabolism: Cold Thermogenesis

The world’s greatest swimmer, Michael Phelps, consumes 12,000 calories each day. Based on my calculations, he only burns 9,602 of these calories leaving him 2,398 extra calories each day that are simply unaccounted for.

Why doesn’t he gain any weight from overeating by the equivalent of more than 4 McDonald’s Big Macs each day (2,398 calories)?  Could these unaccounted for calories be due to cold thermogenesis? Just what is the science behind cold thermogenesis boosting metabolism and will this help me to lose or maintain a healthy weight?

Michael Phelps: The World’s Best Athlete

During the summer of 2008 the entire world was focussed on Michael Phelps at the Olympics in Beijing.  In just 8 short days he went on to win 8 gold medals and set many new world records, a feat never before accomplished at the Olympics.

With the 2012 London Olympics he has earned a total of 22 medals from three Olympics. He is arguably the greatest athlete who has ever lived.  In this inspirational video you can see him win each of these 8 memorable gold medals at the 2008 Beijing Olympics.

Michael Phelps: The World’s Biggest Eater?

While much has been written about Michael Phelps’ training schedule, one thing that is rarely mentioned is the 12,000 calories he eats each day.  Yes, he has a grueling daily work out, but no one can burn that many calories in a day long-term.  What is his secret to not gaining any weight?

As you know from my previous articles, I am a cardiologist who believes in science and I also look for the lessons that we can learn from medical outliers.  Here is my assessment of how Michael Phelps has boosted his metabolism to the point that he can eat 12,000 calories a day and yet not gain a single pound.

Michael is 6 feet 4 inches (193 cm) and weighs 194 pounds (88 kg).  According to the many published reports, he works out 6 hours a day from swimming, weight lifting, and running.  According to the Mayo Clinic, he would burn the following calories:

-A 200 pound (91 kg) man swimming vigorous laps burns 892 calories an hour.

-A 200 pound man weight lifting burns 455 calories an hour.

-A 200 pound man running very fast at 8 mph (17 kmh) burns 1,074 calories an hour.

-His basal metabolic rate or the amount of calories he burns at rest, according to the Haris-Benedict Equation, for an extremely active 200 pound man would be 3,602 calories per day.  This is an overestimate of the calories he burns as he only weighs 194 pounds and would actually burn less.

-Assuming he is burning an overly generous average of 1,000 calories an hour for 6 hours of working out plus his metab0lic rate of 3,602 calories daily (total of 9,602 calories) this leaves 2,398 calories that are completely unaccounted for.

Cold Thermogenesis and Michael Phelps

Could these unaccounted for 2,398 calories be due to cold thermogenesis? Lap swimmers usually swim at 75 degrees Fahrenheit (24 degrees Celsius). Body temperature on average is 98.6 degrees Fahrenheit or 38 degrees Celsius.

From a science perspective, heat loss is 20 times faster in water than air. The reason for this rapid heat loss from water is due to conductive heat loss. This also explains why people can suffer hypothermia in 41 degree Fahrenheit (5 degrees Celsius) water in just 10 minutes whereas you could spend hours outside at 41 degrees if you are dry.

Michael Phelps spends approximately 4 hours in the pool each day. In the cool lap pool he is losing a tremendous amount of body heat. This body heat needs to be replaced by boosting metabolism or burning more calories to stay warm. This term is called “thermogenesis” or the production of heat by the body. Thus, cold thermogenesis refers to the body’s attempt to keep the body warm in a cold environment by revving up metabolism or the burning of calories.

Brown Adipose Tissue or “Brown Fat”

You have probably seen many news articles recently about the role of brown adipose tissue or the so called “brown fat.” Brown fat is opposite the usual fat, or white fat, that we get from gaining weight.

Abundant brown fat can be found in newborns as well as animals that hibernate during the winter. For example, the polar bear has abundant brown fat which helps to keep the bear warm in the harsh arctic climate. As we age, most people lose their brown fat.

Brown fat has extensive blood vessels and burns a lot of calories to keep us warm and regulate our body temperature. Many researchers feel that if we could regain our brown fat that it just might help to reverse the obesity epidemic. Many drugs companies are even looking into creating pills that help people to develop more brown fat in order to boost metabolism and lose weight.

Interestingly, new studies have shown that people who spend a lot of time in cold environments can actually regain their brown fat that was lost as they grew older. Could the key to Michael Phelps’ incredible metabolism be that he has more brown fat than the rest of us?

How to Boost Metabolism with Cold Thermogenesis

Perhaps swimming 4 hours a day in a cold lap pool or a winter lake near your home is not your idea of a good time. The same is true for me. I have tried for years to enjoy swimming and I just can’t seem to make it work for me.

As you know, I live in Salt Lake City and love to exercise outdoors. Summer or winter you can find me on top of one of our local mountains.

I also keep my window open in the exercise room of our house where I keep my treadmill and bicycle desks. The fresh air energizes me, prevents sweating, and results in an increased energy burn. Even as I am writing this, I am in shorts on my bicycle desk with the window open. The outside air temperature right now is 20 degrees Fahrenheit or minus 7 degrees Celsius.

Even if you don’t enjoy exercising in the cold there are still ways you can enjoy the massive calorie burn that comes from cold thermogenesis. Let me give you the answer of how to boost metabolism in three simple steps with cold thermogenesis.

1. Exercise in a cool environment

Of course, exercising in a cool lap pool will boost your metabolism much more than cool air due to the much greater conductive heat loss properties of water. Regardless, even if it is cold in the morning when you get up for your run or walk at least you can tell yourself that the cool air is boosting your metabolism. While this is not an excuse to eat more, at least it can help you to maintain a healthy weight.

2. Turn the heat down in your home

Turning the heat down a few degrees in your home is a great way to save money on your energy bill and boost your metabolism. Indeed, a cooler home will require your body to burn more calories to keep you warm.

3. Drink 8 glasses of cold water daily

Eight glasses of water works out to about 64 ounces or almost 2 liters. While there is no scientific evidence that you must drink 8 glasses of water each day for optimal health, all this cold water does require your body to heat it to 98.6 degrees Fahrenheit or 38 degrees Celsius. This is also cold thermogenesis in action as calories must be burned to heat 2 liters of cold water to a much warmer body temperature.

According to this study, drinking 8 glasses or 2 liters of water burns 96 calories each day. If you do the math, drinking 2 liters of cold water each day without increasing your food intake would burn an extra 10 pounds each year.

The Downside of Cold Thermogenesis: Increased Hunger

By this point you may be thinking that cold thermogenesis is the key to boosting your metabolism and maintaining a healthy weight. While that may be the case, it comes at a significant price. The price is that cold thermogenesis dramatically increases hunger for most people.

I have found that if I am not careful, I tend to eat significantly more food after exercising in the cold.  Studies have also confirmed that cold thermogenesis can increase our appetite . What helps me is to realize this ahead of time so as to avoid mindless eating after exercising in the cold.

I realize that I am not burning as many calories per hour from cold thermogenesis as Michael Phelps as it is cold air rather than a cold lap pool for me. However, I love to start my morning work-outs with 1.5 liters of water. I will then go on to drink another liter or so of water over the rest of the day to keep myself hydrated and keep cold thermogenesis going.

If you can’t control the post-exercise hunger from cold thermogenesis then it could backfire on you and you may end up gaining weight in the process. Knowing how hungry you will be after a cold thermogenesis work out could help to prepare you to find ways to prevent mindless eating afterwards.

Sweating or Evaporative Cooling to Boost Metabolism

Perhaps the hunger that follows cold thermogenesis is too much for you. There is an alternative along the same principle and that is sweating or evaporative cooling to boost metabolism.

In this study, exercising in the heat causes much less hunger afterwards than exercising in the cold. Indeed, if the end result is weight loss and you don’t do well battling hunger then heat may be better for you than the cold. Remember, that if you are in a warm environment you will need much more water to stay hydrated. Does this get us back to cold thermogenesis again?

When it comes to how to boost metabolism it appears that either cold or heat could help you to accomplish this goal. The only difference is the level of hunger that you may experience afterwards.

Cold Thermogenesis Disclaimer

Cold thermogenesis or even exercising in the heat is definitely something that you should not try on your own at home. Likewise, drinking 2 liters of water each day could also be dangerous with some medical conditions like heart or kidney failure. If you are interested in exploring cold thermogenesis further, please work under the supervision of your physician.

Do you prefer exercising in the cold or the heat? How do you manage the hunger pains after exercising in the cold?

#051 Intermittent Fasting, Weight Loss, Longevity

December 6th, 2014 by

Intermittent Fasting, Weight Loss, and Longevity

Could the secret to maintaining a normal weight, avoiding chronic medical diseases, and living a long life be as simple as intermittent fasting? Recent research suggests this is true.  Just what is intermittent fasting as is it something you should do?

Caloric Restriction and Longevity

Restricting calories while still getting the right nutrients for health has been shown to dramatically increase the lifespan of everything from the mouse to the monkey.  For example, caloric restriction, without malnutrition, in mice and rats has been shown to not only increase their lifespan by 30-40% but to also allow them to maintain a youthful appearance.

Caloric restriction appears to slow down the aging process through reduced oxidative stress while at the same time protect the heart and help to prevent cancer. Many repair mechanisms in the body are triggered during periods of reduced caloric intake.

Most of us would love to slow down the “sands of time” and maintain our youth and vitality until very late in life.  For me, I would love to be able to ski until well into my 100s.  However, like most of you, I love to eat and could never willingly practice caloric restriction.

These same life extending benefits of intermittent fasting have not yet been proven to occur in humans.  Also, caloric restriction in humans can be potentially dangerous as you have to ensure that you are getting the right nutrients for health or you could quickly undo any potential health benefits of caloric restriction.

The question naturally arises, is there a better way to achieve the same benefits of caloric restriction without all of the “pain” and potential risks? Fortunately, recent data suggest that intermittent fasting may offer the same benefits as caloric restriction.

Intermittent Fasting

Many different forms of intermittent fasting have been proposed and studied over the years.  These have ranged from reducing calories two days each week, popularized in the Fast Diet, to going without food for 12 to 24 hours.

Many different religions have also promoted fasting for spiritual reasons.  Christians, Jews, and Muslims have practiced intermittent fasting for millennia to gain greater spiritual awareness.

For me, growing up in a religious home I was taught from a young age to fast for 24 hours once each month as a means to gain greater spiritual awareness.  Unfortunately, the hunger pain of fasting for 24 hours was usually too intense for me to obtain much spiritual benefit.

Fortunately, recent data has suggested that fasting for shorting periods of time, such as even just 12 hours, could offer the same health benefits as a 24 hour fast.  A twelve hour fast is something that is relatively easy for most people to do and something you may already be doing without realizing it.

As part of my health turn around several years ago, I started intermittent fasting for 12 hours on most days.  This was not something that I specifically set out to do.

Rather, in efforts to lose weight, I told myself that I had to stop eating by 7 pm each night.  By shutting down the kitchen for me at 7 pm, I naturally fasted for about 12 hours each day.  This is now something that I recommend for my patients who are trying to lose weight and live a long and healthy life.

Intermittent Fasting in China’s Longevity Village

Over the last several years, my wife and I have led a research team studying the centenarians in China’s Longevity Village located in Southwest China near the Vietnam border.  Remarkably, this group of people have been able to avoid the chronic medical conditions that plague us in Western countries.  It was common in this rural Chinese village to see people still working full-time in the fields until well into their 80s, 90s, or even 100s free of disease and the need to take medications.

Of the many principles we learned from these people, which will be described in an upcoming book (here is a link to watch our book trailer), one important factor is that they practiced intermittent fasting every day of their lives.  These centenarians all ate an early and light dinner and then went 12+ hours before their next meal.  This was part of their culture and tradition.

Seven Reasons to Become an Intermittent Faster

1. Weight Loss

There have now been several well designed studies demonstrating that intermittent fasting can be a very effective weight loss strategy.  For example, in this study, women randomized to “relative” intermittent fasting two days a week as they were still permitted to eat on these “fast days,” were still able to lose just as much weight as those who cut their caloric intake every day.

From research performed at my hospital in 448 patients, we found that people who practiced intermittent fasting weighed much less than those who do not.  Even more interesting is that these intermittent fasters were not even trying to lose weight!

Personally, reducing calories for just two days a week sounds a lot better, and possibly even more effective, than trying to cut calories every day.  I suspect that the reason for this is that if you reduce calories every day your metabolism slows down so it is hard to gain any ground.  In contrast, with intermittent fasting you can keep your metabolism high while shedding the pounds.

2. Improved Brain Function

When we go without food for as little as 12 hours our body runs out of stored glucose to burn and starts burning fat.  This fat burning process is called ketosis.

By reducing our dependence on glucose for fuel we can protect our brains from the damaging effects of sugar.  Indeed, intermittent fasting has been shown to improve cognitive function and protect against age related degeneration of the neurons in our brains.  Other studies have shown that intermittent fasting boosts brain derived neurotrophic factor (BDNF) which allows us to create new brain connections, repair failing brain cells, and protect healthy brain cells from damage.

Perhaps this is why religious people for millennia have found spiritual enlightenment with intermittent fasting?

3. Prevent or Reverse Cancer

Intermittent fasting is well known to reduce the tumor inducing insulin-like growth factor 1 (IGF-1).  IGF-1 not only increases the risk of cancer but also allows children to grow big and adults to develop increased muscle mass.

Lower levels of IGF-1, from intermittent fasting, have been shown to prevent or even reverse cancer.  A study published this year showed that a drug which blocks IGF-1 can suppress cancer.

Interestingly, there is a rare genetic condition called Laron Syndrome.  People with Laron Syndrome cannot make IGF-1.  As a result, they tend to be dwarfs but yet live exceptionally long lives free of cancer.  Amazingly, if you give Laron Syndrome people IGF-1 during puberty they will grow to a normal height but yet will still be protected against cancer.

There may be other factors also at play which prevent against cancer with intermittent fasting.  One study even reported that intermittent fasting may be as effective as chemotherapy in fighting cancer.  Please note that I am not recommending intermittent fasting as a treatment for cancer.  If you are battling cancer right now or are just interested in trying intermittent fasting, be sure to talk with your physician first before considering intermittent fasting.

4. Prevent Diabetes

The most commonly reported benefit of intermittent fasting in the medical literature is the prevention or reversal of diabetes.  As mentioned above, going without food for 12 or more hours puts our bodies in a ketotic state.  During this period of ketosis, abnormalities in our glucose/insulin metabolism (insulin resistance) can be corrected so that when we resume eating again our body’s will respond appropriately to glucose and insulin.

An interesting study was published on the effect of Ramadan in people with diabetes.  During the month of Ramadan, Muslims fast from dawn to sunset every day.  An added benefit is that for many Muslims, during the month of Ramadan their diabetes may even go into remission.

5. Prevent Heart Disease

Dr. Ben Horne from my hospital has led a number of research studies looking at the role of intermittent fasting to prevent or reverse heart disease.  His studies have uniformly shown that plaque build up, or coronary artery disease, is less common in intermittent fasters.

In listening to my colleague, there are many potential reasons why intermittent fasting may protect the heart.  Foremost is the effect of intermittent fasting on protecting against diabetes and elevated triglycerides.  However, the most recent research from Ben suggests that other factors might also be involved like the reduction of TMAO which has been associated with coronary artery disease.

6. Restore a Healthy Gut Flora

Increasingly more research is emerging about the importance of maintaining a healthy gut flora and preventing leaky gut syndrome in disease prevention.  Intermittent fasting has been shown to promote a healthy gut flora and may be one additional reason why intermittent fasters enjoy better health.

7. Live a Long and Healthy Life

Many studies in animals show that intermittent fasting may confer the same life preserving effects as caloric restriction.  In addition to the above mentioned mechanisms, it is possible that one additional reason why intermittent fasting may allow for longevity is that intermittent fasting helps to put our bodies into the proper circadian rhythm.

This is certainly one factor we observed during our time in China’s Longevity Village.  These centenarians all had a healthy sleep-wake and feeding natural rhythm.  There is a natural rhythm to life that we need to honor to achieve health and longevity.

Do you intermittently fast?  Intermittent fasting may be as easy as just eliminated that before bed snack.


#043 Lose 18 Pounds a Year with a 10-inch Plate

November 3rd, 2014 by

Lose 18 Pounds a Year with a 10-inch Plate

Do you clean your plate at each meal? If so, then you and I both are part of the 92% of Americans that have this same habit.

Our brains seem to be programmed to clear our plates.  Don’t fight it. Rather embrace it, and turn what you have to your advantage.  Use a small plate.

My Grandpa Black

Where did this habit of cleaning our plates come from? Perhaps it originated from our parents or grandparents who grew up in times of scarcity and let nothing go to waste.

I remember many conversations as a child with my maternal grandfather who we affectionately called “Grandpa Black.” My Grandpa Black lost his parents and lived on the streets of New York City during the Great Depression.  There, as a homeless child, in the worst of the Great Depression he foraged and begged for food to feed himself and his younger sister for whom he was caring.

Grandpa Black lived this nomadic life never knowing where his next meal was coming from for many years. Fortunately, when President Roosevelt introduced the Civilian Conservation Corps program during the depths of the Great Depression, my grandfather enrolled and was assigned to work in Nevada. This got him off the streets of NYC and into a structured environment. There he met my grandmother and they eventually had my mother.

Having endured hunger and starvation through the Great Depression, my mother was raised to never leave a crumb on her plate. That same philosophy carried over to our home growing up.

When we visited Granda Black, he sternly counseled us to never waste our food.  Everything that went on our plate should be eaten.

Cleaning My Plate as a Child

As a child I remember sitting at the dinner table, sometimes for hours it seemed, until I cleaned my plate. Usually, it was a vegetable or a fish that kept me there.  We were taught to never waste our food.

If 92% of all Americans have the habit of clearing their plates, then I can imagine that most of us were probably raised the same way. Don’t waste your food and clear your plate.

For many of us, our modern life is now filled with an over-abundance rather than scarcity of food.

The 10-inch Plate Turned into the 12-inch Plate

This habit of clearing your plate worked well when we used 10-inch plates in the 1950s. Now 12-inch plates are the norm. Just how we got to a 12-inch plate I am not quite sure.

Unfortunately, along with our plate sizes, our waistlines have also increased dramatically since the 1950s.

According to the Centers for Disease Control, over this period of time, burgers and fries tripled in size!  Sodas are now six times bigger than they were in the 1950s.

Overall, we are now eating, on average, 500 more calories than we did a generation or two ago.

How to Lose 18 Pounds with a 10-inch Plate

Just how much more food will you eat with a 12-inch plate? According to the Mindless Eating organization we will eat 22% more.  While hormones definitely play a role to whether we feel full or not, surprisingly, psychology has as much to feeling full as hormones do. The psychology here is that our brain registers that we have “cleaned off our plate” so we must be full.

So, how much weight could we lose simply by switching plate sizes?

Let’s calculate this together. Assuming that the typical dinner is 800 calories, this switch from a 12” to 10” plate size could translate into 176 fewer calories per meal, or 64,240 fewer calories over a year. As each pound of fat is worth 3500 calories, that could mean an 18-pound weight loss each year–just by reducing the size of your plate for one meal! If you did this consistently throughout the day for all meals, your weight loss could be much more. Best of all, this 18-pound weight loss comes without hunger as your brain thinks you are full because you cleared your 10-inch plate.

This psychology works not only with plates but with bowls, glasses, spoons, or whatever else we put food in. If it looks “full” our brains are more likely to register that we are full.

The Portion and Plate Size Challenge

To help you lose 18 pounds or more without feeling hungry, the key is to take advantage of how your brain has been conditioned.  Since your brain is more likely to think you are full when your plate is cleared off, then keep clearing it off, just with a slight twist.

Give it a try! Here are some tips:

1. Replace your 12-inch plate with a 10-inch plate.

2. Downsize your bowls. The size of a bowl could mean the difference between getting a serving of cereal, or say, 5 servings of cereal without even realizing it.

3. Look for a bowl that has measurement lines.  You may be surprised by how much you are actually getting. Many of us have lost track of what a portion size is, or even the ability to tell when we’ve had enough.

4.Use smaller utensils. Smaller utensils are shown to slow down our eating.  Slowing down allows us to discern our satiety when it happens, not 500 calories later past the point.

5. Use a smaller glass if you drink anything but water. A tall thin glass makes you feel you are getting more while delivering less.  If you drink water, the bigger the glass, the better.  More on this in a future blog.

6. When you eat at a restaurant split your meal with a friend or have them plate half of it on a smaller plate and take the other half in a to-go box.

They key is to keep your smaller plate, bowl, or glass “very full” without overeating.  Take advantage of they way your brain has been conditioned and lose 18 pounds each year without ever feeling hungry or deprived!

What size plates and bowls do you use in your home?  Has the smaller plate movement helped you keep portion sizes in check?

#041 Lose Belly Fat with a High Healthy Fat Diet

October 20th, 2014 by

Lose Belly Fat with a High Healthy Fat Diet

Could consuming a liter of olive oil weekly actually help you lose belly fat? According to the latest study, it does.

Indeed, numerous recent studies are showing that replacing simple carbs with healthy fats can help to shrink belly fat.

This goes against everything the American Heart Association and our government taught us for years about eating a low fat diet to lose weight and avoid heart disease. Even the most recent dietary recommendations from our government recommend eating up to a half pound of carbohydrate loaded grains each day.

What would happen if we replaced some of these grains with healthy fats? The key take away from this article is that eating healthy fats will not make you fat but rather could help you to lose the belly fat. It may seem counter intuitive but please read on…

My Transition to a High Healthy Fat Diet

I was no different that the typical American kid growing up in the 1980s. In the 1980s my diet was about 15% protein, 15% fat, and 70% carbohydrates. I dutifully followed the dietary guidelines at that time and drank skim milk, used low or non-fat items, and ate my recommended 6-11 servings of grain each day.

During this period of time, and into the 1990s, I was extremely active physically.  I regularly ran marathons and even started training for an ultra marathon.  Despite these extreme levels of exercise I was still gaining weight on my high simple carb diet (lots of breads, pastas, and pastries).

Things only got worse in the 2000s when high blood pressure, high cholesterol, eosinophilic esophagitis, and an autoimmune disease, among other conditions, also developed. As part of my health turn around a few years ago, I dramatically changed my diet by increasing vegetables 4x and fully embraced a diet full of healthy fats.

Today, my diet is still about 15% protein but now my carbs have dropped from 70% to 40-45%, and my fat has gone from 15% to 40-45% of my diet. The simple carbs have mostly been eliminated  and my nuts and seeds consumption have increased about 10x. Eventually, our government will be forced to acknowledge the ever growing body of scientific data that a diet higher in healthy fats can reverse heart disease, allow us to lose weight, and feel better.

A Balanced Diet

You can’t exclude one of the three macronutirents (fat, protein, carbs) from your diet and expect a healthy outcome. A healthy diet is a healthy balance among the three macronutirents.  My 40-45% fat diet is much higher than the 20-35% currently recommended by our government.

At the same time, my 40-45% fat diet is much lower than the ketogenic diet followers who often target somewhere around 70% fat intake. For me, it is important to keep everything in balance and avoid the extremes until the scientific literature, based on long-term studies, can support these approaches.

From a historical perspective, it is interesting to note that in the late 1800s/early 1900s protein was considered unhealthy. In the late 1900s it was fat that was demonized.  Now in the 2000s it is the carbs.

We absolutely need the right carbs for optimal health, nutrition, and energy. For example, from a scientific stand point, the data supporting fruits and vegetable carbs for long-term health, including cancer and heart disease prevention, are irrefutable.

The Most Recent Study on a High Healthy Fat Diet

In one of the most scientifically rigorous diet studies ever done, researchers have shown that once again people are healthier with a high healthy fat diet. In this study, researchers analyzed 5,801 people randomized to one of three diets.  The three diets evaluated in this study were as follows:

  1. Mediterranean Diet with one liter of olive oil each week
  2. Mediterranean Diet with one serving of nuts daily (walnuts, almonds, and hazel nuts)
  3. Standard low fat diet

The Mediterranean Diet is one also high in fruits, vegetables, fish, nuts, and seeds.  There was no exercise or weight loss goals with this study.  It was purely a diet study for 5 years.

After 5 years, researchers found that those who ate the Mediterranean Diet, supplemented with either a liter of olive oil each week or a handful of nuts each day, had less belly fat and lower triglycerides.  Not only this, the people eating the high healthy fat diet were also 35% (olive oil) and 28% (nuts) more likely to reverse the deadly metabolic syndrome.

Metabolic syndrome is a dangerous condition when at least three of the following are present in a person: excessive belly fat, high blood pressure, high blood sugar, high triglycerides, or low good cholesterol (HDL).

While I do love olive oil, I am still amazed that the people randomized to the olive oil group in this study could eat a liter of olive oil each week and yet not gain weight!

Why are fats healthy?

Don’t be fooled by the fat free label you see in the grocery store! Healthy fats are part of a healthy diet.

Fats are healthy as there are essential fats that our bodies cannot make and that we must get from our diet. Healthy fats are also filling and don’t mess up our hunger hormones and metabolism like a high carbohydrate diet can. The right fats can even reverse heart disease and keep us healthy, vibrant, and strong.

Keep the Right Carbohydrates

In this article I do not want to demonize all carbs.  The simple carbs, like sugar, wheat flour, white rice, processed foods, etc. should be minimized. The complex carbs, like fruits and especially vegetables, should be encouraged at all meals.

I fully support the current 9 daily servings of fruits and vegetables recommended by the American Heart Association. Of these nine daily servings, I would recommend that at least six be vegetables.

What are the healthy fats?

You may be wondering, what are some other healthy fats other than the olive oil and nuts mentioned in this article. Seeds are also loaded with healthy fats. Coconut, avocado, and olives are other great fats. Also, be sure to include the omega 3 fatty fish like Wild Alaskan Salmon, Atlantic Mackerel, sardines, or anchovies.

Dr. Day’s Personal Fat and Carb Rules

Here are my rules as to how I approach fats and carbs in my own diet.

1. I minimize simple carbs

2. I eat at least 9 servings of fruits and vegetables daily (healthy carbs)

3. I eat at least 1 serving of beans or lentils daily (healthy carbs)

4. I eat a variety of nuts and seeds every day (healthy fats)

5. I use organic extra virgin olive oil or coconut oil (healthy fats)

6. I eat Wild Alaskan Salmon at least twice weekly (healthy omega 3 fats)

7. I eat some form of omega 3 fats every day (salmon, walnuts, flax seeds, hemp seeds, chia seeds)

8. I do all I can to avoid hydrogenated/partially hydrogenated oils, vegetable oils, and other “Franken oils” found in processed foods

Do you still find yourself afraid to eat fats, even healthy ones? Why is this? Have you found better health by liberally eating healthy fats? Tell us about it!

#040 Should I Go Gluten Free to Lose Weight?

October 12th, 2014 by

Should I go gluten free to lose weight?

One in three Americans is now going “gluten free” according to a recent survey.  It is interesting that 33% of Americans are excluding gluten from their diets, while only 1% of Americans actually have celiac disease, an autoimmune disease caused from wheat gluten.

Other wheat problems include non-celiac gluten sensitivity which is estimated at 1-6% and less than 1% of the population have documented wheat allergies.

As a cardiologist I am frequently asked by my patients, “should I go gluten free?” In this article I share my experience with going gluten free and explore the reasons for and against going gluten free to lose weight.

My Gluten Free Experience

As many of you know, at the age of 44 I found myself overweight, suffering from multiple chronic medical conditions, and on five medications.  Even as a doctor I did not know where to turn next for help.

I thought that at least if I could lose some weight my health would improve.  I tried reducing what I ate each day but I was not losing any weight. The diet thing just was not working for me. I was hungry all of the time and the free donuts in the doctor’s dining lounge of my hospital kept calling to me.

At that time it was very popular among my cardiology colleagues to go gluten free. In my desperation, I  thought that going gluten free might also help me.  My “gluten free” colleagues all challenged me to give it a “30 day test” to see whether or not I felt better. I thought that since 1-6% of Americans are gluten sensitive, perhaps dropping gluten could help me to feel better as well.

I was excited about the prospect. Yet, just two days into my first attempt at going gluten free, I caved in. My donut, bagel, and pizza withdrawals were too great. I obsessed about the forbidden foods and never felt satisfied with the meals I did eat. With these overpowering cravings, I definitely did not feel any better in the short term. So, almost as soon as I began, I decided to give up.

Two months later, still feeling not very well, I decided to give the gluten free diet another try. This time, I decided to imagine that I had “gluten antibodies” and that I was destroying my body with each donut, bagel, and slice of pizza. In reality, I did not have “gluten antibodies,” but my approach worked to some degree—I lost 10 pounds after two months.

After two months I did not lose any more weight and did not feel much better.  While giving up the junk food helped initially, it wasn’t long before I found gluten free alternative junk food for everything that I craved–cookies, pizza, bagels, you name it. With the re-entry of these foods came the re-gaining of the weight.

Why are so many people having problems with gluten?

Unfortunately, the wheat we eat today is not the wheat our grandparents or great-grandparents ate.  Modern wheat is packed with gluten, far more than what our ancestors ate. Also, modern wheat is in countless processed food products. The toxicities from gluten-loaded wheat and all of the pesticides and other chemicals used in the wheat growing process are triggering many people to develop gluten sensitivities, food allergies to wheat, and full-blown celiac disease.

Celiac Disease is Four Times More Common Today

Celiac disease is increasing at an epidemic rate.  For example, from a recently published study, undiagnosed celiac disease has increased 4 times among Air Force recruits in the last 50 years.

In this study, researchers went back to 9,133 frozen blood samples from Air Force recruits saved from 1948 to 1954 and tested them for gluten antibodies.  They then tested for antibodies to gluten in a modern day similarly matched group of 12,768 people.  Based on their findings, people are now more than 4 times likely to have antibodies to gluten (celiac disease).

We still do not know why so many more people are developing celiac disease today.  Theories range from the increased amounts of gluten we are eating to C-sections to antibiotics to a changing gut flora from our modern life.

Is gluten free healthy?

Is eating a gluten free diet healthier than one with gluten? The short answer is: it depends.  If you have antibodies to gluten (celiac disease) of course you will want to avoid gluten.  For many people who may not have celiac disease, but are gluten sensitive, going gluten free will likely help with your gastrointestinal challenges.

For the rest of us, whether or not gluten free is healthy or not really depends on what you eat instead.  If your diet stays the same except that you now eat gluten free varieties of the same processed foods, then you haven’t really gained anything.  You may even be worse off.

On the other hand, if you replace wheat gluten with fruits, vegetables, nuts, seeds, legumes, or wild fish it could be incredibly healthy. The problem with the Standard American Diet is that we eat too many processed grains, including wheat flour. This processed grain overload is a significant cause of our obesity epidemic.

Even if you tolerate gluten, it may be a good idea to limit the wheat gluten you do choose to eat, considering how much more gluten is in today’s wheat.  For example, non-gluten whole grains such as quinoa could be a healthier option. Alternatively, if  you really do like wheat, like me, try choosing low glycemic sprouted  “whole grain” varieties, like Ezekiel Bread, that are not made with wheat flour. You can buy Ezekiel products at most health food stores.

Should I go gluten free to lose weight?

For most people, going gluten free does not cause them to lose weight. Now that going gluten free is so popular, you can find whatever junk food you crave in gluten free forms. These highly processed gluten free products may even be worse for you than the wheat they were meant to replace.  In fact, I have seen patients actually gain weight eating these “gluten free” junk food options.

The only way to make gluten free a good weight loss option is to replace your processed grains (flour) with real food. If you can replace your grains and processed foods with appropriate portions of real food, physical activity, restorative sleep, and stress management you will see your weight drop quickly.

My Gluten Rules

1. If you have celiac disease, religiously avoid gluten. As many people have undiagnosed celiac disease, I recommend gluten antibody testing for everyone. Talk with your doctor about getting tested.

2. If you think you might have gluten sensitivity, try going gluten free for 30 days. If you feel better off gluten then you probably have a gluten sensitivity.

3. If you have an unexplained medical condition, there is a chance you could have an undiagnosed wheat allergy. Once again, try going off gluten for 30 days to see if things improve.

4. Even if you don’t have celiac disease, gluten sensitivity, or a wheat allergy, most likely your diet and health could benefit by eating less or different grains. Try cutting back or mixing up the grains you do eat. If you love your wheat, avoid the high glycemic wheat flour which is just like sugar to the body.  Try real whole grain sprouted Ezekiel bread which does not have any flour.

5. If you decide to go gluten free for whatever reason, replace the wheat with fruit, vegetables, nuts, seeds, legumes, or wild fish not the highly processed gluten free food products.

6. If you have a question about gluten issues, please talk with your doctor.



#AF-006 Can Weight Loss Cure A-Fib?

January 6th, 2014 by

Can Weight Loss Cure A-Fib, Diabetes, High Blood Pressure, High Cholesterol, and Heart Disease?

Did you see the recent media reports about this study?  Not only did weight loss alone cure atrial fibrillation (A-Fib) but it also cure diabetes, high blood, pressure, high cholesterol, and reversed previous heart damage!

In my opinion, this was the biggest study to emerge from the largest cardiac medical conference in the world, the annual scientific sessions of the American College of Cardiology.  All of my colleagues at the meeting were actively discussing the implications of this study.

The Obesity and A-Fib Epidemic

The United States is at the epicenter of both the obesity and the atrial fibrillation (A-Fib) epidemic.  Carrying extra weight puts a significant stress on the heart which makes it very common for overweight patients to go into A-Fib.  Perhaps this is why A-Fib is 10 times more common in the U.S. than in Asia.

The LEGACY Study

In the LEGACY Study, my friend Dr. Prash Sanders from Royal Adelaide Hospital in Australia, enrolled 355 overweight A-Fib patients in this weight loss study.  To get into the study, you had to have a body mass index of 27 or higher (25 or higher is considered overweight).

To put this BMI number into practical terms, the average weight of the patients participation in this study was approximately 220 pounds.  They divided these patients into 3 groups depending on how successful they were at losing and maintaining the weight loss.  Specifically, I would like to focus on what happened to the 38% of the patients who successfully lost an average of 36 pounds and kept that weight off for one to two years.

Weight Loss Cures Half of Overweight A-Fib Patients

The biggest message of the LEGACY Study is that half of A-Fib patients can be cured by weight loss alone.  Indeed, with just a 36 pound weight loss, 46% of A-Fib patients had their arrhythmias go into remission without medications or procedures.  Even in those who were not able to drive their A-Fib into remission, those who could lose an average of 36 pounds had a 6-fold decrease in their A-Fib burden.

7 Other Benefits of Losing 36 Pounds

In addition to a 50/50 chance of putting their A-Fib in remission, those who lost an average of 36 pounds in this study also had the following 7 additional benefits.  These benefits may even be more beneficial for their health and longevity than just putting A-Fib into remission.

1. 18 Point Reduction in Blood Pressure

Considering that the average blood pressure medication only lowers your blood pressure by 5 t0 10 points (mmHg), dropping your blood pressure by 18 points with simply losing 36 pounds is amazing.  What is even better is that patients dramatically lowered their blood pressure without the nasty side effects that often come from medications!

2. Inflammation Reduced by 76%

C-reactive protein (hsCRP) is a blood test that measures inflammation in the body.  Inflammation is a major cause of heart disease, dementia, and aging.  With a 36 pound weight loss, these patients were able to drop their average dangerous CRP level of 5.1 mg/L to a much safer value of 1.2 mg/L.

The goal CRP level for everyone is less than 1 mg/L.  While these patients did not quite hit this target, their average CRP came very close.  To help put things in perspective, someone with a CRP of 3.0 mg/L or higher has 3 times the risk of a heart attack than someone with a CRP of less than 1 mg/L.

3. 88% Cured of Diabetes

Diabetes is one of the most disabling conditions.  It causes blindness, amputations, kidney failure, heart attacks, dementia, and takes about 8 years off your life.  The good news is that, according to the LEGACY Study, 88% of the time people can be cured of diabetes with just losing 36 pounds!

4. Significant Cholesterol Reduction

The primary treatment for people with high cholesterol is to take a statin drug.  Considering that this recent study showed that statin users are 46% more likely to develop diabetes, this is enough to make anyone reconsider.

An even better way to achieve all of the benefits of statins, without any of the side effects, is to simply lose 36 pounds if you are overweight.  From the LEGACY Study, losing 36 pounds resulted in a 16% reduction in LDL (bad cholesterol) and a 31% reduction in triglycerides.

5. Cure an Enlarged Heart

An enlarged heart can be very dangerous.  An enlarged left atrium can lead to A-Fib.  An enlarged left ventricle can lead to heart failure and cardiac arrest.  Losing 36 pounds resulted in the left atrium shrinking by 18% and the left ventricle coming down 8% in size.

Once again, this is very good news.  It shows that it is never too late to reverse heart damage!

6. Reverse a Thickened Heart Muscle

We like big muscles everywhere in the body except for the heart.  If the heart muscle becomes to big the heart thickens and may have difficulties pumping.  In this study, patients were able to decrease the thickness of their hearts by 14%.

7. Better Quality of Life

At the end of the day the real goal in treating A-Fib is to prevent strokes and improve quality of life.  In this study, losing 36 pounds not only cured half of the patients from A-Fib but also resulted in a 200% improvement in their quality of life!

Can Weight Loss Cure A-Fib?

To get back to our original question, can weight loss cure A-Fib, I hope the answer by now is a resounding “yes.”  This well designed clinical study published in the Journal of the American College of Cardiology showed that there is indeed hope for A-Fib patients!

Not only will half of overweight A-Fib patients be cured with just a 36 pound weight loss but most will also be cured from high blood pressure, diabetes, high cholesterol, and other forms of heart disease.

Does the LEGACY Study inspire you to get down to an ideal weight?


Please work with your physician to determine if you should lose weight and what your target weight should be.  Also, while weight loss may cure you of many chronic medical conditions, the results do not happen overnight.  It took 1-2 years for the patients in the LEGACY Study to experience these benefits.  Thus, continued medications may be required until your target weight is achieved.  Please do not self diagnose or treat based on anything you have read in this article.