Is Whey Really Worth the Hype? If yes, isolate or concentrate?

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The whole town and his wife seems to be using whey protein.

Whey protein isolate is – allegedly – the best protein for improving body composition (reducing fat while improving lean mass)! Or is it really?!

Well, read on to find out!

However, before we get into the nitty-gritty of things, there’s a few queries we need to tackle:

1. Is there a need to supplement with whey, in the first place?
2. And, if yes, which type of whey protein (isolate, concentrate or some other protein) best serves you purpose? Given that whey isolate is the most popular, you have to remember that whey protein concentrate (and, even casein!), can sometimes, give whey isolate a run for its money!

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Why should I take a whey protein supplement?

Resistance training causes increase in muscle mass. This is due to increased muscle protein synthesis (MPS) that resistance training induces (Hulmi et al., 2009; Hakkinen et al., 2001; Hulmi et al., 2007). However, intense workouts alone are not enough to keep packing on lean muscle mass; you have to ‘stay anabolic’ most of the time to be able to keep that MPS working for you.

Without complicating matters, here’s a look at how resistance training increases lean muscle mass: a resistance training session causes muscle protein breakdown. This is then followed by repair of the damaged muscle tissue so that the muscles come out stronger the next time you hit the weights. For the muscles to get stronger, however, proteins ingestion (over and above normal needs) is crucial. Needless to say, the process of repair (recovery) will suffer if you aren’t loading up on proteins.

That resistance training combined with protein supplementation causes muscle hypertrophy is well-documented (Moore et al., 2009; Hulmi et al., 2009; Cribb, Williams, Carey, & Hayes, 2006).  Ingestion of a whey protein supplement either immediately before or after a training session is – considered by some – to be the best for this purpose; also whey increases muscle protein turnover like no other protein.

Whey protein seems to work equally well in women as well (Josse, Tang, Tarnopolsky, & Phillips, 2010).

Another benefit of supplementing with whey is, improved post-workout recovery  This is likely due to the ‘anti-catabolic’ action of essential amino acids (Bird, Tarpenning, & Marino, 2006; Hoffman et al., 2010; Etheridge, Philp, & Watt, 2008).

In those looking to lose weight, whey protein can cause intense appetite suppression and therefore, helps you stay in calorie deficit, thereby inducing weight loss (Veldhorst MA et al., Physiol Behav. 2009: Hall et al., Br J Nutr. 2003)

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What is Whey Protein?

Whey is one of the 2 milk proteins – the other being casein. Casein is the more abundant of the two; it is casein that gives milk that white colour. In commercially available cow’s milk, 20% of protein is whey while the rest of it is casein (Hulmi, Lockwood, & Stout, 2010; Ha & Zemel, 2003; Etzel, 2004; Krissansen, 2007).

Whey is produced in large amounts as a by-product in the cheese industry. However, this whey has fat, milk sugar (lactose) and salts in it and is not suitable for improving body composition per se.

During the process of whey purification, whey concentrate and isolate are produced sequentially. During the initial steps, larger molecules are separated out resulting in formation of whey concentrate. These larger molecules are proteins, lactose, immunoglobulins, amongst other less important ones. To produce whey isolate, cheese whey is passed through an ultra-filtration process (ion exchange or other methods). The ultra membrane filters fat, milk sugar (lactose), salts and other unwanted ingredients leaving behind a pure form of whey (Barile et al., 2009).

Hydrolysates, on the other hand, are formulations where large protein molecules are broken down into smaller fragments. The hypothesis is that this might further increase the rate of absorption of whey. However, this might not be totally true and hydrolysates may not offer much of an advantage over isolates or concentrates.

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Types of Whey Protein

Whey is available commercially as either isolate or concentrate. ‘So, what’s the difference between them and which one should I be using’, you might want to ask?

The main difference between the two is the quality and the amount of protein content – isolate is purer and thus will contain almost 100% protein (well, 90-94% to be precise) while whey concentrate will contain protein ranging from 70-85%.

‘Well, that settles it – I am going with whey isolate!’, you might say. Hang on, not so fast! There is more to it than just protein content.

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Comparing Whey Isolate and Whey Concentrate

Since whey isolate is higher in protein content, has a better amino acid ratio and thus bioavailability, it is absorbed into your system way quicker than whey concentrate (or any other protein, for that matter). That makes whey isolate the ideal post-exercise anabolic drink (Hulmi et al., 2009). Some researchers have suggested taking whey protein isolate before workouts as well in addition to your routine post-workout shake for maximum benefits (Esmark et al., 2001; Cribb & Hayes, 2006). Quicker absorption will mean almost instantaneous rise in blood amino acids which are then taken up by ‘hungry muscles’.

Having said that, the need for immediate post-workout protein supplementation in now being increasingly questioned (more below).

High protein content and higher quality of protein, however, that does not clinch the deal in favour of whey isolate. Concentrate has something up its sleeve that will make sit up and take notice!

As stated earlier, in comparison to isolate, whey protein concentrate will contain lesser amount of protein (in the range of 70-85%). However, somewhat similar to casein, whey protein concentrate will get absorbed slowly – this helps you stay anabolic for longer! Slower absorption also helps with absorption of other important nutrients from food like calcium. Not a lot of people know this but calcium plays an important role in causing fat loss (in addition to keeping your bones healthy)! Add to that the added benefit of appetite suppression for longer and casein suddenly become an important tool for your fat-loss goals or intermittent-fasting health journey…

Furthermore, whey protein concentrate is loaded with immunoglobulins – this helps boost your immune system and therefore may be beneficial in dealing with the intense stresses of training (especially if you happen to overtrain!).

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Whey Isolate

Pros

• • pure; contains 90-94% protein!
  • purity means that it is great for gaining / maintaining lean mass while getting ripped (ideal when nearing competition or a photo shoot)
  • contains all essential amino acids in the best possible ratios
  • bioavailability for humans is best amongst all proteins – meaning, of the amount ingested, more is likely to be absorbed. For instance, in a scoop containing 25 g of whey isolate, almost all of the protein in there, will be going into your muscle
  • lightening fast absorption; ideal post-exercise drink – helps you get into the anabolic mode almost immediately

Cons

• • pricier than whey protein concentrate – to ensure purity, the commercial production of whey necessitates use of complex filtration procedure, hence the price
  • although whey isolate will help recovery after workouts, it loses out to whey concentrate in some respects. This is so because immune boosting constituents of milk protein like alpha – lactoglobulins and lactoferrins are removed during the purification process

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Whey Concentrate

Pros:

• • lot cheaper than whey isolate
  • has a slower absorption rate than whey protein isolates; thus ensures a steady state of elevated amino acids in the blood and helps you stay anabolic for longer. This also reduces the need for frequent dosing
  • slower absorption helps with absorption of other important minerals like calcium and reducing blood glucose and lipid levels
  • induces appetite suppression which may help longer fasting interval, thereby improving body composition and metabolic disease parameters
  • contains immune boosting complexes (alpha – lactoglobulins and lactoferrins) which help post-exercise muscle recovery
  • helps fight diseases – for instance, chronic hepatitis C (Elattar et al., 2010)

Cons:

• • some amount of fat will be present so not ideally suited during times when keeping body fat% down is desirable
  • if you have any degree of intolerance to milk and dairy products, you might want to forget using whey concentrate on account of its lactose content – which is missing from the more purer whey isolate

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TAKE HOME MESSAGE

In conclusion, isolate and concentrate are equally good – however, your circumstances – price, training goals and lactose intolerance – should tip the scales in favour of one or the other.

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Recent developments

1. More recently, the presence of a post-workout anabolic window (of opportunity) is being increasing questioned. ‘Not only is nutrient timing research open to question in terms of applicability, but recent evidence has directly challenged the classical view of the relevance of post-exercise nutritional intake with respect to anabolism’ (Aragon and Schoenfeld, 2013). The amount and quality of protein that you consume throughout the day is, now, thought to be more important than immediate post-workout whey ingestion.
2. BCAAs (branched-chain amino acids – leucine, isoleucine and valine) may be overrated and ‘data do not seem to support a benefit to BCCA supplementation during periods of caloric restriction’ (Dieter BP, Schoenfeld BJ and Aragon AA, 2016). Having said that, adding leucine to whey protein can drastically reduce the need for whey protein.

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Reference List

Aragon AA, Schoenfeld BJ (2013). Nutrient timing revisited: is there a post-exercise anabolic window? Journal of the International Society of Sports Nutrition. 2013;10:5 /1550-2783-10-5.

Barile, D., Tao, N., Lebrilla, C. B., Coisson, J. D., Arlorio, M., & German, J. B. (2009). Permeate from cheese whey ultrafiltration is a source of milk oligosaccharides. Int Dairy J, 19, 524-530.

Bird, S. P., Tarpenning, K. M., & Marino, F. E. (2006). Liquid carbohydrate/essential amino acid ingestion during a short-term bout of resistance exercise suppresses myofibrillar protein degradation. Metabolism, 55, 570-577.

Cribb, P. J. & Hayes, A. (2006). Effects of supplement timing and resistance exercise on skeletal muscle hypertrophy. Med Sci.Sports Exerc., 38, 1918-1925.

Cribb, P. J., Williams, A. D., Carey, M. F., & Hayes, A. (2006). The effect of whey isolate and resistance training on strength, body composition, and plasma glutamine. Int J Sport Nutr.Exerc.Metab, 16, 494-509.

Dieter BP, Schoenfeld BJ, Aragon AA.(2016). The data do not seem to support a benefit to BCAA supplementation during periods of caloric restriction. Journal of the International Society of Sports Nutrition;13:21. doi:10.1186/s12970-016-0128-9.

Elattar, G., Saleh, Z., El-Shebini, S., Farrag, A., Zoheiry, M., Hassanein, A. et al. (2010). The use of whey protein concentrate in management of chronic hepatitis C virus – a pilot study. Arch.Med Sci., 6, 748-755.

Esmarck, B., Andersen, J. L., Olsen, S., Richter, E. A., Mizuno, M., & Kjaer, M. (2001). Timing of postexercise protein intake is important for muscle hypertrophy with resistance training in elderly humans. J Physiol, 535, 301-311.

Etheridge, T., Philp, A., & Watt, P. W. (2008). A single protein meal increases recovery of muscle function following an acute eccentric exercise bout. Appl.Physiol Nutr.Metab, 33, 483-488.

Etzel, M. R. (2004). Manufacture and use of dairy protein fractions. J Nutr., 134, 996S-1002S.

Ha, E. & Zemel, M. B. (2003). Functional properties of whey, whey components, and essential amino acids: mechanisms underlying health benefits for active people (review). J Nutr.Biochem., 14, 251-258.

Hakkinen, K., Pakarinen, A., Kraemer, W. J., Hakkinen, A., Valkeinen, H., & Alen, M. (2001). Selective muscle hypertrophy, changes in EMG and force, and serum hormones during strength training in older women. J Appl.Physiol, 91, 569-580.

Hall WL, Millward DJ, Long SJ, Morgan LM. (2003) Casein and whey exert different effects on plasma amino acid profiles, gastrointestinal hormone secretion and appetite. Br J Nutr. 2003 Feb;89(2):239-48.

Hoffman, J. R., Ratamess, N. A., Tranchina, C. P., Rashti, S. L., Kang, J., & Faigenbaum, A. D. (2010). Effect of a proprietary protein supplement on recovery indices following resistance exercise in strength/power athletes. Amino.Acids, 38, 771-778.

Hulmi, J. J., Ahtiainen, J. P., Kaasalainen, T., Pollanen, E., Hakkinen, K., Alen, M. et al. (2007). Postexercise myostatin and activin IIb mRNA levels: effects of strength training. Med Sci.Sports Exerc., 39, 289-297.

Hulmi, J. J., Kovanen, V., Selanne, H., Kraemer, W. J., Hakkinen, K., & Mero, A. A. (2009). Acute and long-term effects of resistance exercise with or without protein ingestion on muscle hypertrophy and gene expression. Amino.Acids, 37, 297-308.

Hulmi, J. J., Lockwood, C. M., & Stout, J. R. (2010). Effect of protein/essential amino acids and resistance training on skeletal muscle hypertrophy: A case for whey protein. Nutr.Metab (Lond), 7, 51.

Josse, A. R., Tang, J. E., Tarnopolsky, M. A., & Phillips, S. M. (2010). Body composition and strength changes in women with milk and resistance exercise. Med Sci.Sports Exerc., 42, 1122-1130.

Krissansen, G. W. (2007). Emerging health properties of whey proteins and their clinical implications. J Am Coll.Nutr., 26, 713S-723S.

Moore, D. R., Tang, J. E., Burd, N. A., Rerecich, T., Tarnopolsky, M. A., & Phillips, S. M. (2009). Differential stimulation of myofibrillar and sarcoplasmic protein synthesis with protein ingestion at rest and after resistance exercise. J Physiol, 587, 897-904.

Veldhorst MA¹, Nieuwenhuizen AG, Hochstenbach-Waelen A, van Vught AJ, Westerterp KR, Engelen MP, Brummer RJ, Deutz NE, Westerterp-Plantenga MS (2009). Dose-dependent satiating effect of whey relative to casein or soy. Physiol Behav. 2009 Mar 23;96(4-5):675-82.

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Caffeine – Things it does for you!

Get off the Tube – straight into the nearest Caffè Nero  – pick up your favorite coffee and then off to work – isn’t that what most of us do?! Don’t we all love having our coffees, especially first thing in the morning? Yes, we do! – The reason being?! Well, for sure one of the reasons has got to be that coffee really ‘gets you going’ first thing in the morning. But, have you ever wondered how your innocuous looking cup of coffee manages to do that? Read on to find out more.

CAFFEINE

Let’s face it, we have to drink coffee every single morning coz somewhere along the line, we’ve got addicted to caffeine present in our coffee. It is this caffeine that is responsible for the ‘gets me going’ phenomenon!

It shouldn’t come as a surprise then that caffeine is the most ingested psychoactive drug (stimulant) in the world. It is a of major contents of almost all ‘stimulant’ beverages like tea, coffee, cola and energy drinks (not to mention thermogenic fat loss supplements).

According to Starbucks information on beverages, a tall latte’ contains 150mg of caffeine (filter coffee ‘venti’ – meaning twenty in Italian – is low in calories but contain a whopping 400mg per serving). Taking in that amount of the drug can have profound effects on your physiology.

What exactly are these effects and how does caffeine in your tall, skinny latte’ help you to get ‘switched on’, you might want to ask? Well, read on to find out more.

CHEMICAL STRUCTURE AND PHARMACOKINETICS OF CAFFEINE

But before we get into the intricacies of what makes caffeine tick, let us have a closer look at what caffeine really is. Chemically, caffeine is 1,3,7-trimethylxanthine.

Derived from the purine xanthine, methylxanthines have numerous medicinal applications, especially in lung disease. Apart from caffeine, other methylxanthines of note are theophylline, aminophylline (both of which are used as bronchodilators – in asthma), paraxanthine and theobromine. As you may have guessed, methylxanthines are  cardiac and CNS stimulants and bronchodilators (with individual variations, of course).

On ingestion, caffeine is expeditiously absorbed through the lining of the gastrointestinal tract. Within 15 minutes of consumption of coffee, trace levels of caffeine appear in blood; peak concentrations are reached within an hour ¹.

Caffeine is highly lipid soluble (dissolves rapidly and completely in fat). Thus, it can cross cell membranes (of muscle and nerve cells), especially, the blood-brain barrier (a partition which allows only certain chemicals to enter the brain matter).

Caffeine exerts its action (as given below) on various systems through a number of proposed mechanisms.

After exerting its action, caffeine is broken down by the liver and kidneys – metabolites (break down products) that are formed are paraxanthine, theobromin and theophylline¹. Incidentally, these metabolites have actions similar to caffeine as well – theophylline is considered even more potent!

ACTIONS OF CAFFEINE 

As mentioned previously, caffeine is the most often used stimulant in the world with prominent actions on the central nervous system as well as metabolism. As opposed to caffeine present in drinks, anhydrous form of caffeine (in the form of capsule/tablet/powder) is more potent.

Pharmacologically, caffeine is a competitive adenosine-receptor agonist, i.e. it serves as a competition for adenosine at its receptor. This receptor is responsible for suppressing neurotransmitters like adrenaline, nor-adrenaline, acetylcholine, dopamine and serotonin. Thus, ingestion of caffeine increases the production of these neurotransmitters.

However, since these neurotransmitters have complex and sometimes conflicting actions, effects of caffeine in endurance, strength and explosive sports (enhancement of performance, recovery and hydration) can be conflicting as well.

However, the main actions of caffeine can be described as under:

• Cognitive (brain) Effects

Caffeine improves wakefulness and vigilance. It may be also responsible for improved skill levels, especially those acquired through repeated training ².

Foskett et. al. demonstrated in their study, improved cognitive parameters in athletes due to caffeine ingestion with enhanced sprint abilities as well as ball passing, ball control and accuracy associated with acute ingestion of caffeine³.

Because caffeine in low to moderate doses (3-6 mg/kg of body weight) has been shown to cause improved concentration during sleep-deprived spells, it may find application in services like the Special Forces ².

• Thermogenic Effects

Consumption of caffeine causes stimulation of metabolism and a significant increase in the production of energy ⁴ – thermogenic action of caffeine has been shown to last for almost 3 hours after ingestion ⁴. Caffeine causes mobilization of free fatty acids and fat oxidation to produce energy during exercise ^5-7. Additionally, it causes extra-muscular fat oxidation as well. Thus, caffeine seems to be definitely associated with causing fat loss ⁷.

These metabolic-stimulatory (adrenergic) and fat-burning effects make caffeine a crucial ingredient of almost all fat-loss supplements (thermogenics).

• Enhanced Exercise ability 

It is believed that caffeine enhances exercise performance. This is owing to its ‘glycogen-sparing effect’ – decreased utilization of muscle glycogen for energy during exercise – fats are used instead. Thus, owing to muscles glycogen lasting longer, the setting in of fatigue is prolonged.

Also, caffeine supports formation of new glycogen (glycogenesis) and thus aids in recovery after an intense exercise session.

Enhanced secretion of endorphins induced by caffeine is also a presumed mechanism in enhancing exercise performance ⁸ – the resultant decrease in pain perception leading to ‘feel good factor’ of beta-endorphins is well-documented ⁹.

In addition to the above findings, research also suggests that caffeine can improve neuromuscular transmission and muscle contraction ^10;11 – both isometric and muscle endurance components are improved ¹⁰.

 To conclude, research overwhelmingly supports the view that caffeine enhances performance in endurance events ^5;12, sports involving muscle power-strength components ^13;14 as well as high intensity team sports ^14;15.

Take Home Message

So, the next time you are sipping that favourite coffee of yours, you know exactly what it is doing to you!

To sum up, caffeine has the following effects:

• is more potent when ingested in the anhydrous state (as a tab/capsule/powder supplement rather than as coffee)
• aids in sports performance
• improves skills acquisition in sports – like ball control and passing
• supports new glycogen formation (glycogenesis) and thus helps quicker recovery from an exercise session
• prolongs exercise induced fatigue – by their ‘glycogen-sparing’ effect so you can keep going for a longer
• improves neuromuscular transmission and muscle contraction
• has thermogenic effects – stimulates metabolism causing burning of calories
• induces fat loss – mobilizes fatty acids from fat stores and uses these as substrate (instead of glycogen) for producing energy
• improves concentration – especially during sleep-deprived states
• secretes beta-endorphins – makes you feel good

 References

1.  Harland BF. Caffeine and nutrition. Nutrition 2000; 16(7-8):522-526.
2. Lieberman HR, Tharion WJ, Shukitt-Hale B, Speckman KL, Tulley R. Effects of caffeine, sleep loss, and stress on cognitive performance and mood during U.S. Navy SEAL training. Sea-Air-Land. Psychopharmacology (Berl) 2002; 164(3):250-261.
3. Foskett A, Ali A, Gant N. Caffeine enhances cognitive function and skill performance during simulated soccer activity. Int J Sport Nutr Exerc Metab 2009; 19(4):410-423.
4. Astrup A, Toubro S, Cannon S, Hein P, Breum L, Madsen J. Caffeine: a double-blind, placebo-controlled study of its thermogenic, metabolic, and cardiovascular effects in healthy volunteers. Am J Clin Nutr 1990; 51(5):759-767.
5. Ivy JL, Costill DL, Fink WJ, Lower RW. Influence of caffeine and carbohydrate feedings on endurance performance. Med Sci Sports 1979; 11(1):6-11.
6. Erickson MA, Schwarzkopf RJ, McKenzie RD. Effects of caffeine, fructose, and glucose ingestion on muscle glycogen utilization during exercise. Med Sci Sports Exerc 1987; 19(6):579-583.
7. Spriet LL, MacLean DA, Dyck DJ, Hultman E, Cederblad G, Graham TE. Caffeine ingestion and muscle metabolism during prolonged exercise in humans. Am J Physiol 1992; 262(6 Pt 1):E891-E898.
8. Laurent D, Schneider KE, Prusaczyk WK, Franklin C, Vogel SM, Krssak M et al. Effects of caffeine on muscle glycogen utilization and the neuroendocrine axis during exercise. J Clin Endocrinol Metab 2000; 85(6):2170-2175.
9. Grossman A, Sutton JR. Endorphins: what are they? How are they measured? What is their role in exercise? Med Sci Sports Exerc 1985; 17(1):74-81.
10. Kalmar JM, Cafarelli E. Effects of caffeine on neuromuscular function. J Appl Physiol 1999; 87(2):801-808.
11. Lopes JM, Aubier M, Jardim J, Aranda JV, Macklem PT. Effect of caffeine on skeletal muscle function before and after fatigue. J Appl Physiol 1983; 54(5):1303-1305.
12. Hogervorst E, Bandelow S, Schmitt J, Jentjens R, Oliveira M, Allgrove J et al. Caffeine improves physical and cognitive performance during exhaustive exercise. Med Sci Sports Exerc 2008; 40(10):1841-1851.
13. Woolf K, Bidwell WK, Carlson AG. The effect of caffeine as an ergogenic aid in anaerobic exercise. Int J Sport Nutr Exerc Metab 2008; 18(4):412-429.
14. Beck TW, Housh TJ, Schmidt RJ, Johnson GO, Housh DJ, Coburn JW et al. The acute effects of a caffeine-containing supplement on strength, muscular endurance, and anaerobic capabilities. J Strength Cond Res 2006; 20(3):506-510.
15. Schneiker KT, Bishop D, Dawson B, Hackett LP. Effects of caffeine on prolonged intermittent-sprint ability in team-sport athletes. Med Sci Sports Exerc 2006; 38(3):578-585.

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The Obesity Paradox – Why there may be a silver lining to being fat!

Health and fitness professionals and researchers (me included!) have always cried hoarse about the downsides of obesity. For decades, obesity has been reported to impair health and reduce longevity (Allison et al., 2008). So much so, that research community has branded obesity as a disease (2008) which increases mortality and decreases longevity (Fontaine, Redden, Wang, Westfall, & Allison, 2003). There is, also, strong proof for causal effect of obesity in increasing mortality (4, 5). Conversely, calorie restriction (I don’t totally agree to calorie deficit plans – they aren’t for everyone!) to lower body weight has been shown to prolong life (Weindruch & Walford, 1988).

Notwithstanding the strong evidence for obesity being a curse, there are some curious findings about obesity in humans – those that will make you wonder if being fat is really that bad for you! There seems to be a reason why we gain weight as we age – well, in that case, does obesity afford some protective effect on human existence? Research into the so-called ‘obesity paradox’ certainly points in that direction.

Obesity Paradox

Obesity seems to have a protective effect in people suffering from a major injury or illness; this is called obesity paradox – in such individuals, being fat helps in that it increases survival time.

‘Among persons who already have heart failure, outcomes seem to be better in obese persons as compared to lean persons’ (Niedziela et al., 2014).  The direct causal relationship of obesity in this curious phenomenon is, however, a matter of intense debate (Habbu, Lakkis, & Dokainish, 2006).

Another equally curious observation reported by academicians is that lower body mass indices (underweight or those just under normal) are associated with an elevated mortality rate.  While individuals who are mildly overweight reflect the lowest mortality rates (Childers & Allison, 2010 and Niedziela et al., 2014). Mind you, the extremely obese are worse off though!

Take home message

Although ‘leaner is better’ may be true in most people – especially, in those who are disease-free and injury-free – obesity does seem to provide benefits in the diseased or injured, particularly in middle-aged individuals. This may be part of the reason why we put on weight as we age (Heo et al., 2003).

However, before you jump the gun and start advising middle-aged people to forget about getting lean, do keep in mind that there is, as yet, no conclusive evidence for the protection offered by being overweight or downright obese. Further research providing concrete proof needs to be conducted before we change our views on obesity.

Until that time, I’m afraid, its back to Olympic lifting platforms and HIIT and your nutrient-dense meals! Go people…!

 References 

Obesity as a disease: The Obesity Society Council resolution (2008). Obesity (Silver.Spring), 16, 1151.

Allison, D. B., Downey, M., Atkinson, R. L., Billington, C. J., Bray, G. A., Eckel, R. H. et al. (2008). Obesity as a disease: a white paper on evidence and arguments commissioned by the Council of the Obesity Society. Obesity (Silver.Spring), 16, 1161-1177.

Childers, D. K. & Allison, D. B. (2010). The ‘obesity paradox’: a parsimonious explanation for relations among obesity, mortality rate and aging? Int J Obes (Lond), 34, 1231-1238.

Fontaine, K. R., Redden, D. T., Wang, C., Westfall, A. O., & Allison, D. B. (2003). Years of life lost due to obesity. JAMA, 289, 187-193.

Habbu, A., Lakkis, N. M., & Dokainish, H. (2006). The obesity paradox: fact or fiction? Am J Cardiol, 98, 944-948.

Heo, M., Faith, M. S., Mott, J. W., Gorman, B. S., Redden, D. T., & Allison, D. B. (2003). Hierarchical linear models for the development of growth curves: an example with body mass index in overweight/obese adults. Stat.Med, 22, 1911-1942.

Niedziela J, Hudzik B, Niedziela N, Gasior M, Gierlotka M, Wasilewski J et al. The obesity paradox in acute coronary syndrome: a meta-analysis. Eur J Epidemiol 2014; 29(11):801-812

Weindruch, R. & Walford, R. (1988). The Retardation of Aging and Disease by Dietary Restriction. Springfield, IL: C.C. Thomas Publisher.

 

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