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Define “Body Image”: “The subjective picture or mental image of one’s own body”.

The key here is that it is subjective. There is not objective way to view our own bodies. We can use objective measurements (height, weight, waist, et al…) but those objective ‘factual measurements’ will always be viewed through the skewed lens of our own psyches.

Can be positive or negative.

Women AND Men have issues with body image.

Women-

• Often relates to being smaller / thinner

Often relates to being larger / bigger / taller

Men have just as many issues with body image as women do but are often not allowed to share those thoughts for fear of being outcast or ridiculed by peers. The adonis complex is a perfect example where men are told they need to have massive ‘shoulder boulders’, huge biceps, a chiseled chest and back. For many men it is difficult to put on weight or lean mass. It is also unrealistic to compare the amount of time you can devote to training vs. the professional body builder whose JOB is to be a gym rat and create his/her physique.

2014 study in JAMA found that adolescent boys are increasingly affecting with body dysmor

https://jamanetwork.com/journals/jamapediatrics/fullarticle/1766495

So Can you have positive body image AND always being pursuing improving health / performance and physical appearance???

Recognize, you will likely never “arrive” at the perfect look or the best performance, and that is okay.

It is human nature to push to be better.

Imposter syndrome

How Do we combat negative body image?

• Gratitude journaling related to the way you look

Things Pete Learned today.....

Autophagy necessary to prevent cancer.

https://www.nature.com/articles/s41586-019-0885-0?fbclid=IwAR38qMSbtdSORlt2xUDYrm6oRHmsvctKzxz2tXQ-fC33Qt20_F3fyrZ6PJ8

https://www.sciencedaily.com/releases/2019/01/190123131706.htm?fbclid=IwAR1rw8sGJWNNNxkj6nY5Ag_78UxmVwp0QFYcQBYkKA6LzDaT9tKxP3Wcl8U

Question: If metabolically healthy, do you need to eat a ketogenic diet?

• NO

Question: Why does it matter as long as you are doing the right thing for you?

• Maybe it doesn’t

What is Emotional Eating

• Eating when you are not hungry, often with underlying emotion as a cause

Boredom Worth talking about

• We live in a society where we need to be occupied at all times (social media)

When was the last time you sat down at the table by yourself with no one else, no phone, no computer and ate a meal slowly. (I don't remember the last time I did this

What Do we Eat

Not broccoli

Why We Do It

• To distract (stress / sadness)

When do we emotionally eat (if we do)

Emmy? ALL THE DAMN TIME. My two most common emotions are boredom and stress. Stress when kids are whining / crying. Stress after shift (even driving home in car). Boredom during watching a movie or evening, if Pete is out and after kids go to be. Overnight shifts.

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Emmy -The adenovirus, one of the most widely studied viruses and causes very benign sxs is linked with obesity

the virus DNA enters the adipocyte (fat cell) and increases the uptake of fat making it larger. It also causes increase (adipogenesis) in number of fat cells by a genetic mechanism.

more proof that it is not calories in and calories out

Pete - “Weight on knee....

1lb of weight loss is equal to 4lbs of weight loss in the knee which is walking and it becomes amplified. The mechanics of the knee....Your center of gravity and how that applies torque into the knee is part of the reason that body weight is amplified. So it’s not just pound for pound. When patients gain a pound, it’s 4lbs for walking, 6lbs more for going up and down stairs, 8lbs more with running. It’s a significant multiplier.

There are similar multipliers for the hips and back.”

-Dr. Eric Chehab quoted in The Peter Attia Drive podcast

Emmy - Spatchcock Chicken

Pete - For every 2.2lbs (1kg) of weight you gain there is a 9% increased risk of getting diabetes. Diabetes is the leading cause of: kidney failure, blindness, non traumatic lower limb amputation, and the 7th leading cause of death in the United States in 2015.

 Emmy - CCK (cholecystokinin) is secreted by small bowel in response to FAT and PROTEIN and stomach distention. Within 15-30 minutes it makes you feel full by decreasing your stomach emptying, and stimulating the neurological pathway in the hypothalamus to make you stop eating.

GLP-1 (glucagon like peptide) is secreted by bowel in response to CARBOHYDRATES. It too makes you feel full by several mechanisms. It's degrades much quicker. GLP-1 levels are decreased in Obesity, pre-diabetes, and diabetes. This means with obesity and diabetes you are more hungry

Pete - Peripheral metabolic effect of exercise ---->Muscle produces myokines ---> causes increased mitochondria (browning) of fat ---> increased adiponectin ---> causes increased insulin sensitivity

Emmy - Shift Workers

rotating shift workers have higher post meal glucose, insulin, and triglycerides blunted post meal ghrelin secretion (no feeling full) reduced Leptin (tells your brain your full) elevated glucose and insulin all the time elevated cortisol leading to fat gain & increase blood pressure if sleeping < 5.6 sleep/day sig reduced metabolic rate

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What is Serotonin?

Neurotransmitter (allows nerves to talk to each other). biological function is complex and multifaceted, modulating cognition, reward, learning, memory, and numerous physiological processes

Produced in the GI tract primarily but also the brain (Hello gut health influences brain health!!!!!)

Serotonin is produced, does a job and then then is cleared by reuptake. Various agents can block re-uptake and increase serotonin:

SSRIs (a kind of antidepressant e.g. sertraline (zoloft), cocaine

Regulates mood, sleep (improves sleep), appetite, highly involved in behaviors requiring high cognitive function, learning and memory

From a weight loss perspective

• Serotonin stimulates the same pathway as Leptin

The weight loss drug Belviq or lorcaserin stimulates serotonin receptors in the hypothalamus

Why do we want to naturally increase serotonin?

Positive mood is linked to longevity and decrease risk of all cause mortality

Ways to increase Serotonin

Sunlight (or bright light (3000 lux)?) exposure (at the right time of day)

Bright light during the night hours might disrupt serotonin levels

           “Light cafes” pioneered in Scandinavia have come to the United Kingdom

GET OUTSIDE for a walk (lunch break/morning etc.)

Exercise

Anti-depressive and anti-anxiety effects of exercise have been documented over and over.

      The most consistent effect is seen when regular exercisers undertake aerobic exercise at a level with which they are familiar

We think this is due to increase serotonin

Diet

  Tryptophan is an amino acid which is a pre-curser for serotonin. Unfortunately it’s hard to get that tryptophan you eat in your diet to your brain due to the meal you are eating it with. Due to interactions too complicated to go into here, it does not reach the brain easily.  When eating foods with other amino acids, they compete for access to your brain. Its very hard to get things past your blood-brain barrier (the semi-permeable barrier between your blood and cerebrospinal fluid). Not everything you put in your blood (or gut for that matter) reaches the brain.   

*** this is the problem with MANY supplements that you waste your money on. Supplements promising better mood / sleep etc. may not actually make it to your brain.

Scientists have been trying to figure out how to manipulate the meal make up so that more tryptophan makes it to the brain

A few studies showing eating foods high in dietary tryptophan can improve memory and mood

You can google what foods have lots of tryptophan (eggs/salmon/almonds/ etc.).

Make sure you eat these things with a little carb as studies show this improves the ability for your body to use the tryptophan

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2077351/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4728667/

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Chronic:

• Increase in cortisol stimulates neuropeptide (NPY) - hunger pathway (discuss)

• Brown fat is the fat on babies and decreases throughout life

The more fat the more cortisol (having fat is a stressor to itself)

ANOTHER vicious cycle.

Half of patients with obesity have hypercortisolism and have are normal. If high cortisol higher risk for heart disease

DECREASE STRESS BY

• Reasonable exercise

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Thanks to our new Patreon supporter “Drew from Liverpool, England!”.

Asked about dopamine and other hormones. We will get there!

Inverse correlation between measures of obesity and testosterone levels.

The larger the waist the lower your testosterone

Prevalence in men with type 2 diabetes is 40%

Low testosterone

Insulin resistance, increase fat mass, high cholesterol, high blood pressure, increase risk, diabetes, of heart attack

Independent risk factor for ALL cause mortality

Symptoms of low testosterone

• Fatigue,

Obesity causes low testosterone because testosterone is converted to estradiol (an estrogen) by aromatase enzymes in fat cells. More estrogen causes feminization of men. 'Moobs'. Decreased fertility

Then reduced testosterone increases adipocyte (fat cells) (vicious cycle) and decreases lean mass (worsening body composition)

Testosterone also works on something called the hypothalamic-pituitary-testicular axis. This hormone “highway” connects  your brain to your reproductive organs. Obesity acts on this highway to reduce testosterone

What to Do

• Weight loss from diet, exercise, bariatric surgery sig increase testosterone levels

Testosterone replacement (or increasing your own)

• Increase lean body mass

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Why are we talking about this?

Tracey Crouch was just appointed the U.K.s minister of Loneliness. Loneliness is a huge growing public health issue in most developed countries

⅓ of older Americans report feeling lonely and isolated

This has long term health consequences including function decline and increase risk for heart disease, stroke, dementia, insomnia (and we know what that does!).

Individuals without meaningful social relationships are twice as likely to die from all cause mortality. IS THERE ANYTHING ELSE SO RISKY?!

“It’s proven to be worse for health than smoking 15 cigarettes a day, but it can be overcome and needn’t be a factor in older people’s lives,”

• Mark Robinson, the chief officer of Age UK, Britain’s largest charity working with older people

Higher risk populations: new parents, children, disabled people, refugees

Dr. Holt-Lunstad at Brigham Young, who has analyzed 70 studies encompassing 3.4 million people, said that the prevalence of loneliness peaks in adolescents and young adults, then again in the oldest old.

people can be socially isolated and not feel lonely; they simply prefer a more hermitic existence. Likewise, people can feel lonely even when surrounded by lots of people, especially if the relationships are not emotionally rewarding.

But can affect ANYONE at any time.

I have felt many times in my life and still do at times.

Why do we have this problem

• No mix between young and old generations (retirement is just bad for most people!)

Abraham Maslow (psychologist) considered the most basic of needs — warmth, food, shelter, security and a sense of connection. (he later added the concept of transcendence)

1. Physiological Needs

It's hard to admit you feel Lonely (it's embarrassing)

Often in the ER we see physical complaints even though there might be a more pressing issue like loneliness underlying this

What do we do???

If YOU are lonely

• Don’t blame yourself

If You are NOT LONELY

• Recognize many are and reach out

https://www.wbur.org/cognoscenti/2018/12/28/misery-anton-chekhov-jay-baruch

https://www.nytimes.com/2018/01/17/world/europe/uk-britain-loneliness.html

https://www.nytimes.com/2017/12/11/well/mind/how-loneliness-affects-our-health.html

https://www.simplypsychology.org/maslow.html

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3303190/

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