May Newsletter
In This Issue
What Did The "Biggest Losers" Really Lose?
The Fantastic Four
Keep The Pressure Down
A New Model of Medical Care
Dr. Niedfeldt
Old-fashioned medicine with 21st Century convenience and technology
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I hope this newsletter finds you and your family well. It's great to have a Memorial Day Weekend with fantastic weather! I hope all of you were able to take to some time to get out and enjoy it. As I write this on Memorial Day, it is a good time to reflect and give thanks for the men and women who have served our country. I am especially proud of my father, who served in Vietnam. It is sobering to remember those who made the ultimate sacrifice to keep us safe. They certainly weren't concerned about "safe spaces" or "microaggressions" but went into harms way so we could have a country where a main topic of conversation is who gets to use which bathroom rather than being jailed for speaking our minds. My thanks to you and your families for your service.   

"The Biggest Loser" is a popular reality TV show which has aired in the United States since 2004. Contestants attempt to lose the most weight to win a cash prize. The winner is the contestant who loses the highest percentage of their original body weight. The show has multiple spin offs in over 32 countries. But what happens to the contestants after the show is over? Is this dramatic weight loss healthy? This month's first study looking at contestants 6 years later gives us some answers. 


What if we could reduce cancer deaths by over 50% use a 4 part regimen; would you be interested? What if that regimen didn't involve using any medications at all? What if four lifestyle behaviors could reduce the incidence of cancer by 50% and deaths from cancer by well over 50%? Interested now? Check out the second article. 


Vascular dementia is the second most common dementia. Keeping blood pressure down earlier in life is proving to be a way to prevent the development of this disease. Should you be concerned? The third article gives us some answers. 


Click on the links the the left to check out our web site...

What Did The "Biggest Losers" Really Lose?
Metabolic rate continues to be lower years later          
The authors of this study, published in the journal Obesity, evaluated metabolic adaptation in 14 participants of "The Biggest Loser" weight-loss competition over 6 years by measuring changes in resting metabolic rate (RMR) and body composition. At the end of the competition, participants lost an average of 128 lbs and RMR decreased 610 kcal/day below baseline. At 6 years' follow-up, participants had gained back an average of 90 lbs, RMR decreased 704 kcal/day below baseline, and metabolic adaptation was −499 kcal/day. There was an association between weight loss at 6 years and metabolic slowing. Despite regaining most of the weight lost during the competition, the RMR remained decreased. 
Summary of findings:
  • OBJECTIVE:  To measure long-term changes in resting metabolic rate (RMR) and body composition in participants of "The Biggest Loser" competition.
  • METHODS: Body composition was measured by dual energy X-ray absorptiometry, and RMR was determined by indirect calorimetry at baseline, at the end of the 30-week competition and 6 years later. Metabolic adaptation was defined as the residual RMR after adjusting for changes in body composition and age.
  • RESULTS: Of the 16 "Biggest Loser" competitors originally investigated, 14 participated in this follow-up study. Weight loss at the end of the competition was (mean +/- SD) 58.3 +/-24.9kg (P < 0.0001), and RMR decreased by 610 +/-483 kcal/day (P = 0.0004). After 6 years, 41.0 +/- 31.3 kg of the lost weight was regained (P = 0.0002), while RMR was 704 +/- 427 kcal/day below baseline (P < 0.0001) and metabolic adaptation was -499 +/- 207 kcal/day (P < 0.0001). Weight regain was not significantly correlated with metabolic adaptation at the competition's end (r = -0.1, P = 0.75), but those subjects maintaining greater weight loss at 6 years also experienced greater concurrent metabolic slowing (r = 0.59, P = 0.025).
  • CONCLUSIONS: Metabolic adaptation persists over time and is likely a proportional, but incomplete, response to contemporaneous efforts to reduce body weight.

Why do we regain weight? We often blame ourselves for lack of will power or motivation, or we talk about a body weight set point and how the body will fight its way back your original weight. This study looked at 14 participants in "The Biggest Loser" competition to see what happened to them 6 years after the show. All of them had huge motivation and plenty of will power. They had a team to help them stay on track, and they lost a significant amount of weight during the show. Yet, 6 years later, almost all had gained much of the weight back. The mean weight loss at the end of show was about around 128 lbs; but, after 6 years, they regained 90 lbs of it back. What went wrong?

The researchers measured their resting metabolic rate (RMR), which is the minimum number of calories that we burn just to stay alive. At the beginning of the show, the measured RMR was 2577 kcal/day, which is right in line with what we would expect for their age and weight (2607 kcal/day). However, by the end of the 30 weeks of intense exercise and dieting, the predicted RMR was 2272 kcal/day but the actual RMR was only 1996 kcal/day. Because of the severe exercise and dieting, their bodies kicked into survival mode and became more efficient. This adaptation, designed to protect us from famine, is now keeping them from maintaining their weight loss. They are able to survive with burning fewer calories. 

The most interesting finding is that after 6 years they were still in that very efficient mode. At 6 years, their predicted RMR was 2403 kcal/day, but their actual burn rate was only 1903 kcal/day, which means that they were burning almost 500 kcals less than we would expect. Even if they ate like a normal-weight person, this efficiency means that they can still have a surplus of 500 kcals. And 100 kcals extra a day becomes 10 pounds over a year, so 500 kcal daily would mean 50 pounds in a year!

Based on these findings, many obese people may actually eat normal amounts of food but still gain weight because their metabolism is so efficient that a few hundred kcals are saved every day.

The Biggest Loser ,while inspiring to watch as people turn their lives around, may not be making a good long-term impact on the contestants. Forcing morbidly obese people to exercise intensely 6-8 hours daily simply isn't realistic. Exercise doesn't have to be excruciating. The best way for overweight people to transform is to do resistance training regularly (body weight, bands or weights), walk every single day, and start replacing sugar and junk foods with home cooked meals including lean sources of protein and food from Mother Nature instead of a box. Eat meals at the dining table rather than at the wheel. Additionally, many also need to learn to cope with their emotions in non-food ways.

But perhaps the best thing we can do is understand that there are no quick fixes. Rapid and extreme weight loss can cause what appear to be permanent issues with our metabolism. We should avoid making the body so efficient. Avoid the extreme diets that trigger the survival instincts which drive our bodies to become more efficient. Slower and steady weight loss through gradual changes in diet and exercise is the long-term solution. Remember that the weight didn't all get put on over a few months, therefore, it shouldn't all come off quickly either. Go gentle with weight loss and avoid triggering that "survival alarm."

The Fantastic Four
Most cancer deaths prevented through four lifestyle changes

Most cancer deaths among white Americans could be prevented through four healthy lifestyle changes, according to a study published in JAMA Oncology.
The results are based on 135,910 U.S. health professionals, followed since the 1980s, divided into two groups: one considered to have a low risk of cancer, based on the four lifestyle factors; and a higher-risk group. People in the low-risk group were normal-weight or mildly overweight; had never smoked; either abstained from alcohol or drank moderately (no more than one drink per day for women, or two per day for men); and got at least 2.5 hours of moderate exercise every week. 
Over the years, the low-risk group had fewer cancers. If the higher-risk group had followed the same lifestyle habits, one-quarter to one-third of their cancers could have been avoided and close to half of their cancer deaths might have been prevented. Because the study group consisted of health professionals, they actually had healthier habits than the average American. The
researchers then used federal cancer statistics to see what could happen if all white U.S. adults met those same lifestyle standards. They estimated that roughly half of cancer diagnoses could be averted, along with 67 percent of deaths among men and 59 percent among women. Cancers of the lungs, throat, kidneys, liver, bladder, colon, and pancreas would all show significant declines.

Summary of findings      
  • Importance: Lifestyle factors are important for cancer development. However, a recent study has been interpreted to suggest that random mutations during stem cell divisions are the major contributor to human cancer.
  • Objective  To estimate the proportion of cases and deaths of carcinoma (all cancers except skin, brain, lymphatic, hematologic, and nonfatal prostate malignancies) among whites in the United States that can be potentially prevented by lifestyle modification.
  • Design, Setting, and Participants  This prospective cohort study analyzes cancer and lifestyle data from the Nurses' Health Study, the Health Professionals Follow-up Study, and US national cancer statistics to evaluate associations between lifestyle and cancer incidence and mortality. 
  • Exposures  A healthy lifestyle pattern was defined as never or past smoking (pack-years <5), no or moderate alcohol drinking (≤1 drink/d for women, ≤2 drinks/d for men), BMI of at least 18.5 but lower than 27.5, and weekly aerobic physical activity of at least 75 vigorous-intensity or 150 moderate-intensity minutes. Participants meeting all 4 of these criteria made up the low-risk group; all others, the high-risk group.
  • Main Outcomes and Measures  We calculated the population-attributable risk (PAR) by comparing incidence and mortality of total and major individual carcinomas between the low- and high-risk groups. We further assessed the PAR at the national scale by comparing the low-risk group with the US population.
  • Results  A total of 89,571 women and 46,339 men from 2 cohorts were included in the study: 16,531 women and 11,731 men had a healthy lifestyle pattern (low-risk group), and the remaining 73,040 women and 34,608 men made up the high-risk group. Within the 2 cohorts, the PARs for incidence and mortality of total carcinoma were 25% and 48% in women, and 33% and 44% in men, respectively. For individual cancers, the respective PARs in women and men were 82% and 78% for lung, 29% and 20% for colon and rectum, 30% and 29% for pancreas, and 36% and 44% for bladder. Similar estimates were obtained for mortality. The PARs were 4% and 12% for breast cancer incidence and mortality, and 21% for fatal prostate cancer. Substantially higher PARs were obtained when the low-risk group was compared with the US population. For example, the PARs in women and men were 41% and 63% for incidence of total carcinoma, and 60% and 59% for colorectal cancer, respectively.
  • Conclusions and Relevance  A substantial cancer burden may be prevented through lifestyle modification. Primary prevention should remain a priority for cancer control.

All I can say about this study is wow! More than half a million Americans die of cancer, the second-leading cause of death in the U.S. every year. 
Each year, cancer costs the world more money than any other disease, according to the American Institute of Cancer Research (AICR). 
Cancer costs $895 billion annually. Comparatively, heart disease costs $753 billion. Nothing else comes close, with traffic accidents and diabetes each costing about $204 billion. 

Four lifestyle changes make the difference, being normal-weight or mildly overweight; never smoked; either abstained from alcohol or drank moderately (no more than one drink per day for women, or two per day for men); and got at least 2.5 hours of moderate exercise every week.

That's it! Over half of cancers prevented! The lives saved, suffering alleviated and money saved is staggering. Let's get to work on this!

Keep The Pressure Down...
Link between high blood pressure and dementia stroke
Vascular dementia is the second most common cause of dementia. This study, reported in the journal Stroke, fount that systolic blood pressure (the first number in the blood pressure reading), was a strong independent predictor of vascular dementia. Over a 7 year period, the relative risk of newly diagnosed vascular dementia increased by 60% for every 20-mm Hg increase in usual systolic blood pressure above 120 mm Hg for patients aged 30-50 years, and 26% for those 51-70 years of age.   

Summary of findings:   
  • BACKGROUND AND PURPOSE:  Vascular dementia is the second most common form of dementia but reliable evidence on age-specific associations between blood pressure (BP) and risk of vascular dementia is limited and some studies have reported negative associations at older ages.                           
  • METHODS: In a cohort of 4.28 million individuals, free of known vascular disease and dementia and identified from linked electronic primary care health records in the United Kingdom (Clinical Practice Research Datalink), we related BP to time to physician-diagnosed vascular dementia. We further determined associations between BP and dementia in a prospective population-based cohort of incident transient ischemic attack and stroke (Oxford Vascular Study).  
  • RESULTS: For a median follow-up of 7.0 years, 11,114 initial presentations of vascular dementia were observed in the primary care cohort after exclusion of the first 4 years of follow-up. The association between usual systolic BP and risk of vascular dementia decreased with age (hazard ratio per 20 mm Hg higher systolic BP, 1.62; 95% confidence interval, 1.13-2.35 at 30-50 years; 1.26, 1.18-1.35 at 51-70 years; 0.97, 0.92-1.03 at 71-90 years; P trend =0.006). Usual systolic BP remained predictive of vascular dementia after accounting for effect mediation by stroke and transient ischemic attack. In the population-based cohort, prior systolic BP was predictive of 5-year risk of dementia with no evidence of negative association at older ages. 
  • CONCLUSIONS: BP is positively associated with risk of vascular dementia, irrespective of preceding transient ischemic attack or stroke. Previous reports of inverse associations in old age could not be confirmed.
This study looked at two groups. The first was a review of 11,114 patients who developed vascular dementia. An association between higher blood pressure and higher rates of vascular dementia was noted, with higher levels of blood pressure leading to higher levels of vascular dementia. Once people are over 70 years of age, the relationship disappears as the risk of vascular dementia increased greatly with increased age. The second group was a prospective group which involved almost 1700 patients with a recent first TIA or stroke who were initially free of vascular dementia. Over 5 years, the risk of new-onset dementia (by follow-up specialist examinations) was strongly linked to systolic (and diastolic) blood pressure levels measured during the preceding 2 decades. 

This study makes a good argument for aggressive blood pressure control for younger people to help decrease the risk of vascular dementia with aging.  
Thank you for taking the time to read through this newsletter. I hope you have found this information useful as we work together to optimize your health. 


Rapid and dramatic weight loss makes us feel good, it now appears to have permanent negative effects on our metabolism (resting metabolic rate). This makes the 'slow and steady' approach to weight loss seem even more prudent. That weight didn't get there overnight, it certainly shouldn't disappear quickly. 


Four behaviors, 50% less cancer. Don't think about them, do them!


Vascular dementia is another terrible disease that we may be able to prevent with proactive treatment. If your blood pressure is high, let's get it under control. Your brain is depending on you. 


As always, if you have questions about anything in this newsletter or have topics you would like me to address, please feel free to contact me by email, phone, or just stop by! 

To Your Good Health,
Mark Niedfeldt, M.D.