From WebMD Live's Mind and Body Auditorium - "Fight Fat After Forty," with Pamela Peeke, MD, MPH.
Pamela Peeke is an internationally recognized expert and speaker in the fields of nutrition and stress, as well as the newly evolving field of Integrative Medicine. Dr. Peeke received her baccalaureate from the University of California at Berkeley before going on to the University of Michigan, where she earned a Masters Degree in Public Health and Public Policy, then her doctoral degree. After over ten years as a specialist in critical care and trauma, she received the Pew Foundation Postdoctoral Scholarship in Nutrition and Metabolism from the University of California at Davis. Dr. Peeke is also Assistant Clinical Professor of Medicine at the University of Maryland School of Medicine, a medical correspondent for PBS "Health Week," and Medical Advisor and member of the Board of Directors of the International Spa Association. Dr. Peeke has appeared as an expert on numerous television programs, including "The Oprah Winfrey Show," "Nightline," "CNN Headline News," "CBS This Morning," and "Later Today," as well as being interviewed by several publications, including Newsweek and The Washington Post. Dr. Peeke was featured in the PBS special, "Mind Over Mirror: Women's Body Image," which won the 1998 Gracie Award, the highest honor bestowed by Women in Film and Television.
Moderator: What exactly is toxic stress and how does it make us fat?
Dr. Peeke: Toxic stress is a form of stress which is characterized by being chronic, unrelenting, uncontrollable -- that's all perceived by your head -- and associated with the two evil twins, hopelessness and helplessness. When you feel that and you take it with you, day in and day out, and you do this for a long time, what you find is that it will stimulate higher than normal levels of stress hormone, cortisol. And, when that hormone stays high, what it tends to do is stimulate a chronic appetite. And, over a period of time, that chronic appetite will clearly be adding on extra pounds. And, if you are over the age of say, 35 or 40, but definitely over 40, those extra pounds begin to accumulate in a very unique place, deep inside the belly, below your abdominal muscle wall. How does that occur? It's because that fat, deep inside the belly, is the normal source of fuel for stress, for the fight and flight. If you chronically keep your stress hormone up, it simply signals to the body to continuously store fat there. And, the poor body doesn't know that you're just walking around with intellectual stress and not doing any physical activity to address it.
Moderator: So there is no difference between real physical stress and intellectual stress?
Dr. Peeke: That's correct. What ends up happening is any kind of stress, whether it is physical or psychological, intellectual, any kind of stress like that will still end up being the same stress, whether it's stress from a medical condition that you're dragging around daily, like, "I can't believe I have breast cancer," or, if it's a social thing, "I can't believe my friend turned on me." All of those things will basically pan out to stress. It's all the same thing in the end and that's what we're talking about here. There are really three kinds of stress in the world as I see it. One is life threatening stress. That's straightforward and absolute. There is another kind of stress that I wish everyone would convert all stress to, and that is, annoying stress. What's happening with annoying and livable stress is the fact that everything in life can be perceived this way. A little bit irritating and annoying, the long line at the grocery store or the detour on the way to work. Those things should never have to turn into toxic stress. People are dragging these with them day in and day out, and the grand majority of our stresses in life should most definitely be converted in our minds to annoying but livable stress, then you control the level of cortisol. You keep it below the appetite-stimulating threshold. So that, what you don't have are these stress overeating impulses which happen all the time when toxic stress is out of control.
Moderator: What medical studies support the science behind the stress-fat connection?
Dr. Peeke: The first thing is, in our laboratory as well as the laboratory of one of my colleagues in Sweden, what we've found was that if you use molecular biology and you look for the receptors for cortisol on fat cells throughout the body, the greatest number of receptors you'll find, and this is analogous to the greatest activity for fat storage, occurs only in the deep belly fat. We've looked at fat from the hips, thighs, and buttocks, and the "pinch an inch" fat, and it was the fat deep inside the belly that was clearly the place where receptors were highest in population and activity. So when you have higher levels of cortisol, they'll make a bee-line to that place. That's why I call it stress fat. Secondly, in animal studies -- when the primates are placed under toxic stress, induced by either reorganizing the hierarchy of the colony or lack of sleep or naturally occurring causes -- what we've found is that when they feel toxic stress and how an animal feels it, is it feels defeated. When a human feels toxic stress, that feeling of helplessness and hopelessness is defeat. When an animal feels this way, they develop the entire syndrome that humans do, which is the development of toxic weight, the extra weight deep inside the belly and the metabolic syndrome which means you also develop high blood pressure, higher heart rate, diabetes, increased risk for stroke and blood clotting as well as cancer. And, the cancer we've found most highly associated with the toxic weight is colon cancer. This came out about a year ago by the National Cancer Institute. Finally, the human studies where Dr. Scrive at Yale found that women who have more of this toxic weight, in other words they are apple shaped vs. pear shaped. These apple-shaped women when placed under stress, meaning asked to speak before an audience or asked to do math problems, when you measure the amount of stress hormone in their urine versus the women who are pear-shaped , the apple-shaped women always had statistically significant higher amounts of cortisol. This was borne out by male studies just completed by Dr. Bjorntorp in Sweden. What he did was study men in 1998 and found that looking at about 250 middle-aged men about 50, when he studied their salivary cortisol, he found those men who had the greatest amount of toxic weight, largest hip to waist ratios, they always had a higher overshoot of the cortisol consistently throughout the day. They had higher blood pressures, heart rates, insulin levels and by definition had the greatest sense of feeling out of control, i.e., toxic stress. This was just published in the Journal of Clinical Endocrinology and Metabolism. That was in June 1998.
The work that we did at the NIH, the National Institutes of Health, was with Cushing Syndrome. This is a rare syndrome (one in one million is the definition of a rare syndrome) where a completely normal individual begins to develop a microscopic tumor in the pituitary or adrenal glands. Remember these glands are part of the stress axis, and their major outcome is simply to increase the amount of stress hormone in the human body. These people may have stress hormone levels equal to having a gun pointed to your head 24 hours a day, and they don't even know it until they're diagnosed. So, what we found was something interesting. If the only thing wrong with these people is that they have high levels of stress hormone, why do they look like they do? The women look like pumpkins and the men look like pregnant women. And, no one could figure that out so I decided to take that on. The reason why I was interested in this is because the fat was causing the metabolic syndrome and killing them. They were all getting high blood pressure and heart disease and diabetes. I said to myself, if it's happening to them in extreme ways, what is happening to the common man? If someone is walking around with big-time stress in their brain all the time, then there surely is a correlation and that's when we started to put the work together.
Moderator: Why are women over 40 at greater risk for developing toxic weight?
Dr. Peeke: It's men and women both. The real question here is men and women are both at greater risk over age 40 for developing toxic weight in general, let alone involving stress. For one, sex steroids are declining. In men, testosterone, in women, estrogen. Testosterone protects a man from putting on lots of fat deep inside his belly. He'll tend to do it mostly in the "pinch an inch" area, but after 40 it will be more in the deep belly. Estrogen in women prior to age 40 keeps fat on the hips, thighs and buttocks. Those cells have estrogen receptors that are plentiful. Now, why do we have fat there? Because of breast feeding. The estrogen puts fat there to be able to allow you to have a fuel source for breast feeding. The three factors for toxic weight are: Poor lifestyle choices, eating too much relative to no physical activity, declining sex hormones, so testosterone for men and estrogen for women prior to the age of 40 protects them from putting on too much fat deep inside the belly. After 40, you lose that protection. And then the third is the new player on the block, toxic stress.
Moderator: How do we control the levels of cortisol?
Dr. Peeke: We control it by using our head and our body together. First, if you do not see something as stressful, it isn't. So, it's a matter of perspective. In your mind, you can convert something from potentially toxic to annoying but livable. Number two, enlist your body to help your mind. For instance, when a micromanaging boss gets in your face and tries to make you feel miserable, you might respond by leaving the office and then taking a walk to be able to neutralize the stress response. At the same time, the walking will help you think clearer about the specific problem. It is a beautiful example of mind and body working well together. The key is to modulate and control the stress hormone level below the appetite threshold, so that you don't feel like overeating and running into problems.
Moderator: What is "CortiZone?"
Dr. Peeke: The CortiZone is the time from 3 pm to approximately midnight when cortisol levels and adrenaline levels are naturally falling according to their daily biorhythm. When that occurs, usually beginning around 3 to 4, people become very tired or less energetic, and become frustrated because they do not understand that it is normal to feel less energy at that time of day. Mindless eating and stress levels which are increasing out of frustration are the deadly duo that put on the toxic weight during this time. Unfortunately, people's choice of food at this time makes this even worse. The key here is that I call the 3 to 4 hour the vending machine hour or the 'frappuccino' hour. What's happening is, when you eat what I refer to as low quality, high stress foods (refined sugars), that increases your insulin level. High insulin combined with high stress hormone from toxic stress is the perfect combination to add belly fat.
Moderator: How do exercises, such as walking, yoga, and weight training, act as fight-and-flight simulators?
Dr. Peeke: What ends up happening is the brain is quite primal and it assumes that you will address the stresses of your life physically, i.e., fight and flight. The problem is that we don't do that anymore. Today we have tremendous stresses, but they are intellectual stresses. And, as such, it never occurs to us to address them physically. Instead, what most people do is what I refer to as the 21st century rendition of the fight and flight, which is called the "stew and chew." We are now saying to ourselves, "Is there any way to be able to rectify this situation?" And the answer is yes. You simulate fight and flight by deliberately going out of your way to make certain it happens. When you lift weights, you're fighting. When you're biking or cross training or walking or stair climbing, you're flighting. And when you intersperse that throughout the day by getting up once a day from your computer and walking around, you modulate stress hormone and bring her back down where she belongs.
Moderator: What foods neutralize stress eating and when should we eat them?
Dr. Peeke: Protein combined with high quality, low-stress carbohydrates. Now, what are those? First of all, protein, in and of itself is marvelous at cutting carbohydrate cravings. Again, high quality and low-stress protein. A perfect example would be a breakfast that includes an egg-white omelet which is high-quality protein, versus the alternative, which could be sausage. Sure it's protein, but it's riddled with animal fat. So, we're looking specifically at something like egg whites, with low fat cheese for more protein. Turkey bacon is excellent, or canadian bacon. Those are perfectly fine. The carbohydrates come from high fiber, whole grain bread -- NOT processed, not white, but dark and whole grain. That's the first piece of the action. The second is fruit. It gives you bulk fiber and fructose as a source of sugar fuel versus sucrose, which is the white, refined sugar. When you eat fructose from fruit, you do not require the same level of insulin as the refined sugars, therefore, not getting the high insulin rise which can increase appetite.
Moderator: Do diets like the now popular high-protein/high-fat diets help fight toxic weight?
Dr. Peeke: Well, tune in tomorrow when I debate Dr. Atkins. I'm doing it between 3 and 4 EDT. The key that you're looking for here is to avoid extremes. We all agree that refined sugars are a problem. However, you do not throw the baby out with the bath water. The bath water we already all agree on, so why don't we just stick with the bath water. What's with the carrots? When was the last time you binged on carrots? The thing that drives it more than anything else is refined, processed foods. They went too far. They extrapolated data too far, and erroneously assumed that all fruits and vegetables were as problematic as refined sugars, which is absolutely incorrect. The way you should be eating is that the grand majority of people over age 40 need to be combining at every feeding time, high-quality low-stress proteins, carbohydrates and fat. I usually recommend that you, after age 40 especially, that you try to get in 65% or majority of calories before 5 pm. It's called inverting the triangle. Because most people eat like a triangle which is why they look like it, too. There's nothing subtle about this. If you don't want to look like it, stop eating like it. After age 40, you must leave that "Leave It To Beaver" ethic behind you and grow up. The bottom line is that 65% of what you should be eating on a daily basis should be done by 5 pm. And that dinner should be much, much lighter. That's why I call it the carbohydrate clock, which is in the book and says, go ahead and have your high-quality, low-stress starches like brown rice, whole wheat or spinach pasta or the high-fiber breads. But, try this. After 5 pm, for dinner, about five or six days a week, eliminate all starches. And use starches only at night time as a treat, no longer as a staple. When you were younger they were a staple, but as you age they become a treat. So dinner begins to look like salads, vegetables, protein and fruit. This is perfectly fine
Moderator: How do high-quality fo9ods help fight stress eating?
Dr. Peeke: What they do, number one, is reduce the physical stress of the high levels of insulin which are constantly being secreted when you eat the low-quality, high-stress foods so physiologically you're decreasing stress, number one. Number two, you're decreasing the psychological stress of having known that you just ate something inappropriate. It's psychological and physiological stress versus feeling satiated by protein and appropriate carbohydrates and not having any psychological or physiological stress that goes along with that.
Moderator: You're big on weight and strength training. Why is this?
Dr. Peeke: Very simple. If you don't use it, you lose it. And, for every pound of muscle that you lose because you didn't keep it going, then what happens is you lose the capacity to burn 35 to 50 calories a day. It's like losing cylinders under your hood. What happens then, and it really makes sense, is between age 30 and 50 a woman specifically can lose anywhere from five to 10 pounds of muscle. Do the math. If you lost 10 pounds of muscle, then multiply that by either 35 or 50. You will be eating 350 to 500 calories less because you do not have the capability to burn calories. Thus, the little whine we hear from everyone is, "Why is it I'm eating the same thing I ate 10 years ago and yet I'm gaining weight?" I just explained to you how. Now, the strength training maintains your muscles and by doing that you can eat more efficiently. It's that simple. Plus the added benefit is that you will stay stronger physically, which turns out to be one of the greatest predictors of living long and healthfully, number one. Number two, the next thing it does is maintain metabolic heat, meaning that if you are maintaining your muscles well, you can burn calories efficiently. And then you will fit into your clothes much better at a higher weight. And, when I ask you a question out there in America, what would you prefer? A weight or a size? Trust me, it's a size. When you put on the jean-o-meter or if you're a man, a belt-o-meter -- I call those the clothes-o-meters -- when you put those babies on and they fit fine, who cares what you weigh? That's why I ask people out there to be more concerned with how they feel in their clothes-o-meters. How many of us know people who have skinny arms, skinny legs and a pot belly? If you look at the weight alone on a scale, you'll miss where the weight is actually being carried. My book, Fight Fat After Forty came out four weeks ago and has appeared on "NBC Dateline" and also USA Today with a full-cover story. The web site is www.fightfatafter40.com.
The advice provided by Dr. Peeke is hers and hers alone. If you have any medical questions about your health, you should consult your personal physician. This event is meant for informational purposes only.
