Of Dreams and Reality

ENERGY EXPENDITURE (EE) & BODY WEIGHT

The ability to store unused energy (surplus to immediate requirements) is an obvious asset when food availability is erratic (irregular) and more especially when scarce.
However a continuous (regular) surplus can in time result in overweight and ultimately obesity.
Thus to correct (or prevent) obesity both EE (energy expenditure) and EI (energy intake) need to be quantified as clearly (unambiguously) as possible.

QUANTIFYING THE INCREASE IN EE LINKED TO A SPECIFIC PHYSICAL ACTIVITY

The EE linked to a specific physical activity (walking for example) only replaces the EE linked to the activity (TV watching, resting, sleeping, etc.) it has displaced.
Failure to realise this can lead to incorrect daily EE totals.

The following example is used to illustrate this.
[To calculate the increase in EE for an adult (weighing 79 kilograms) when 55 minutes of TV watching is replaced by a 3.5 mph (miles per hour) walk.
The following quantities (see: Obesity Simplex in Google Search page 1) are taken into account:
(a) EE per kilogram per minute walked at 3.5 mph = 0.06292 Calories
{EE per pound per minute walked at 3.5 mph} = 0.0286 Calories}
(b) EE per kilogram per minute of TV watching = 0.0165 Calories]
{EE per pound per minute of TV watching} = 0.0075 Calories}]

Calculation:

EE during walk = 79 (weight) x 0.06292 (Calories per minute) x 55 (minutes)
= 273.40 Calories
EE during TV watching = 79 x 0.0165 x 55
= 71.70 Calories
Therefore the increase in EE = 273.40 – 71.70 Calories
= 201.70 Calories

[Note:

1) Calculations which do not take into account body weight are misleading (ambiguous).
2) A heavier person’s EE linked to a specific physical activity is greater than that of someone who is lighter (for that very same activity if carried out for the same length of time).
3) Consequently a heavier person needs to spend less time on a specific physical activity to achieve the same EE as a lighter person. This fact may be regarded as the sole advantage that a heavier body weight can bring.
4) Calculations in pounds of body weight should be based on appropriate {figures} above.]

“BIOLOGICAL MODEL OF ADDICTION"

Introduction

The results of excessive drinking are well known.
What makes the individuals who constantly drink too much ignore them is to a great extent a mystery.

In “Invitation to Psychology” the two co-authors C. Wade and C. Tavris (1999) (Addison-Wesley Educational Publishers) discuss the two dominant approaches to understanding addiction which they refer to as “Biological Model” and “Learning Model” respectively.
They also attempt to integrate the contributions of both “models”.

Here in Alcohol II are listed the key points of the “Biological Model of Addiction” (as stated by Wade and Tavris).

[Note: It is for you to decide how ambiguous (if at all) they are!!!!]

Biological Model of Addiction (key points)

A. Genetic Involvement

1) It is possible that several genes in combination affect:
a) The response to alcohol (including the metabolism of alcohol by the liver)
b) The compulsive use of alcohol
c) The progression of alcohol-related diseases (including cirrhosis)

2) It is possible that genes contribute to temperament or traits that predispose some people to become alcoholics (alcohol dependent).

3) It is also possible that:
a) “…genes have little to do with alcoholism…” and
b) “…alcoholism results, basically from alcohol!”

Alcohol Involvement

1) Heavy drinking:
a) Alters brain function
b) Reduces the level of pain-killing endorphins
c) Produces nerve damage
d) Shrinks the cerebral cortex
e) Damages the liver

2) “In the view of some researchers, these changes then “create”:
a) “… biological dependence ..”
b) “... inability to metabolize alcohol..”
c) “…psychological problems …”

I WONDER IF ‘ANY OF THE ABOVE’ HAS CAUSED YOU TO STOP*, PAUSE AND THINK (IF BUT FOR A BRIEF MOMENT)!!!!!!!!

Many ambiguities surround alcohol and the drinking of it. One of the most interesting ones is whether or not it is a drug of true addiction.

This brief introduction to alcohol related ambiguities leans heavily (if not solely) on the following statements made by Robert Kemp, T.D., M.D., F.R.C.P. (circa 1972) in ‘Drinking And Alcoholism’ (A Family Doctor booklet published by the British Medical Association):

1) Alcohol is “not a true drug of addiction as are morphia, heroin or cocaine.”
[Note: R. Kemp refers to morphia (morphine), heroin and cocaine as “hard drugs”.]

2) “Anyone who systematically takes any of these “hard” drugs will quickly become a true addict. The tissues develop a real craving with serious withdrawal symptoms if the drug is not forthcoming so that a drugless life is almost impossible and recovery rare.”

3) The drinker “can live perfectly normally without alcohol though naturally he misses its effects and prefers life with it to life without.”

4) Dependence on alcohol is “on an emotional basis rather than on a physical level. This means that those who drink excessively do not do so because their tissues are craving drink and they themselves have become physically dependent on this substance.”

5) “The fact that there is no true addiction makes treatment possible and recovery likely.”

I WONDER WHAT YOUR VIEWS ARE ON THE ABOVE STATEMENTS.

Exfoliation (known biologically as desquamation) is a normal feature (activity) of the skin surface (superficial dead and keratinised cells of the outermost horny layer).
It is the process of shedding worn out horny cells in the form of invisible scales (collections of small numbers of cells).

Products (e.g. creams) and treatments associated with it, together with its abnormalities (due to disease) can be said to constitute another set of bodily ambiguities.

[Note:
Disease aspects will only be mentioned in passing].

The skin (as a whole) is the ultimate barrier and connection between the body and the environment.

Its ability to protect against the entry by many harmful environmental agents (including microbes) depends to a great deal on the chemical composition and physical construction (nature) of its very surface (made of the outermost cells of the horny layer of the epidermis).

[Note:
Various substances (produced mostly by the epidermis itself) help the cells of the horny (outermost and dead) layer of the epidermis to carry out some of their barrier functions].

The skin surface is best described as transient because the cells of which it is made are continuously being shed (desquamated or exfoliated) and replaced. Such a constantly ‘renewed’ surface offers the best possible protection to the rest of the skin (including the deeper living layers of the epidermis) and the body as a whole.

[Note:
1) There are limitations to the protection a thin layer of biological materials which constitutes the skin surface (outermost rows of the horny layer) can offer.
2) Nevertheless it has kept human kind in existence for a long time!].

Cells migrate from the layers immediately below to take the place of those (‘worn out’ ones) that are desquamated (exfoliated in everyday language).

The cells that move upwards (or outwards) from row to row until they are exfoliated all originate from the deepest layer of the epidermis which is called the basal layer.

[Note:
1) During the migration from the basal layer to the horny layer each epidermal cell undergoes differentiation (over about 14 days) which changes it from a soft and living structure to a dead and toughened (keratinised) one.
2) Horny cells spend about another 14 days in their 'dedicated' layer and then are desquamated (exfoliated)].
3) Skin scales make up most of ordinary household dust.

Shedding of visible scales (collections of larger numbers of horny cells) is abnormal. This can occur in infectious conditions (e.g. ring worm) and non-infectious conditions (e.g. sunburn, eczema, psoriasis, etc.)].

Additional to the normal desquamation that follows epidermal cell differentiation (and migration) is the desquamation that is facilitated (accelerated) by routine skin-centred activities. These include washing, shaving, make-up application and removal, etc. Friction against clothing, bedding, etc. has the same effect.

Thus for the normal (healthy) skin, treatments and products designed or aimed specifically to bring it about (exfoliation) could be said to be unnecessary and perhaps in some cases excessive.

Note of Caution:
Excessive exfoliation can have detrimental effects in the long run, especially if epidermal differentiation and replacement cannot keep pace with it.
A good example of ‘swings and roundabouts’, I would be inclined to say!

Cellulite I (Introduction).
Cellulite (also referred to as “so-called cellulite”) is a very good example of bodily ambiguities.
[Note:
a) It should not be confused for cellulitis (a bacterial infection of the skin and subcutaneous tissues by Streptococcus pyogenes).
b) However both cellulite and cellulitis can affect (although differently) the same tissues].

In this introductory part (for cellulite), mainly quotations {with my notes in ( ) and [ ]} from the Journal of Dermatologic Surgery and Oncology (March 1978) will be used to illustrate this.

1) From Morris Leider.
The French word cellulite was suddenly thrust upon the lay public in the country (US) some years ago in commercial advertisements of “beauty” parlors and other agencies that offered treatment for a certain dimpled appearance of the ordinarily well –covered skin of mature women.
[Note:
a) The dimpled appearance of the skin (referred to above) has been described in much earlier French publications as resembling the skin of an orange or the surface of a mattress.
b) Reasons for the two different appearances will be discussed at some other time].

2) From Earle W. Brauer.
(A) Cellulite is a cosmetic “defect that consumes and tortures millions of European women.
[Note:
a) The term cellulite made its entry in French medical literature in 1816. However it is not certain that it was applied precisely to same condition that we discuss here].
b) It was not until 1978 that two papers about so-called cellulite (or cellulite for short) were published in English (in the journal mentioned above)].

( It is a normal “abnormality” that has spawned a billion-dollar industry of futile treatment both within the legitimate medical/surgical collegium and in that fringe of lay persons who call themselves “estheticians”.
[Note:
a) “Estheticians” as referred to above is a direct translation from the French “estheticiennes”.
b) In modern terms they would be referred to in the US as cosmetologists and in the UK as beauty therapists.]

3) From F. Nurnberger and G. Muller
A) It has been claimed but never proven that so-called cellulite is attributable to internal illnesses, birth-control pills, environmental pollutants and miniskirts.
[Note:
The more likely causes will be discussed at some other time]
It is an important obligation of physicians to teach the fact that so-called cellulite is not a disease but is the result of the sex-typical structure of the skin of women and a natural sequence of ageing.
[Note: Involvement of the sex hormones in skin structure will be discussed at some later time].

4) From C. Scherwitz and O. Braun-Falco
A) Since so-called cellulite is not a real illness, there is no meaningful or effective therapy by medications
[Note: Therapy proposed by the above authors will be discussed at some later time].

Obesity simplex: Childhood Obesity Management Without Food Intake Reduction.

The management of childhood obesity (once established) should not involve a reduction of food intake (as a means for reducing the body weight).

Children (obese or not) require a balanced diet which can support the growth and maturation processes.
Restricting the food intake can introduce the risk of a lack of one or more essential nutrients.

Instead the aim should be to maintain the weight constant whilst the child grows in height. By so doing the weight and height should ultimately be compatible with each other.

Thus the RELIED 500 Cal Plan (in its entirety) is not recommended for the management of Obesity simplex in children.

However, introducing in the child’s daily routine, one or more activities aimed at producing a raised expenditure (RE) of energy is to be encouraged.

It is worth noting that in 1994, E. Obarzanek and his associates showed that both obesity and blood cholesterol levels correlate with hours of television viewing (Volume 60 of American Journal of Clinical Nutrition, pages 15 to 22).

[Note: Children also spend a lot of time working at computers and playing video games].

TV viewing may have the added effect of fostering snacking, often on foods that are rich in calories (chocolates, sweets, peanuts, potato crisps/chips, etc.).

[Note: TV advertising of the above foods can play a significant part in this]

Someone unfamiliar with the RELIED 500 Cal Plan may mistakenly believe that it recommends a daily intake of 500 Calories (which a 500 Cal plan, if it existed, would recommend).
In fact:
1) The RELIED 500 Cal is based on the production of a deficit of 500 Calories per day as suggested by Mark Bricklin (1979) in his book “Lose Weight Naturally” published by Rodale Press, Emmaus, Pennsylvania.
2) The deficit should be arrived at by the production of:
a) A Raised expenditure (RE) of energy of 200 Calories and
b) A Lowered intake of energy (LI) of 300 Calories
[Note: This quantity of energy represents the 300 in Mark Bricklin’s “Natural 300 Plan”]

Mark Bricklin’s quantities (figures) are a good reference/starting point.
However, as stated in earlier entries of the present series, the RELIED 500 Cal Plan allows for flexibility with regards to actual quantities concerning raised energy expenditure (RE) and lowered energy intake (LI).
[Please see previous entries, more especially “Obesity simplex (primary obesity): Facing up to its reality” and “Practical aspects of the RELIED 500 Cal Plan (A concise user’s manual)”].

Moreover, as the body weight changes more adjustments can and need be made but it is recommended that the RE (raised expenditure) remains a permanent feature.
This is essential for general health reasons, and more especially, if one wanted to maintain the newly acquired ‘desired’ weight over a significant (meaningful) period of time (if not on a permanent basis).
[Note: The RE should be quantified on an individual (personalised) basis (please read previous entries, more especially: “Walking as a means of producing a net expenditure of 200 Calories].

Thus one difference between the RELIED 500 Cal Plan and the ‘Natural 300 Plan’ relates to methodology (and also, possibly emphasis).
Everyone can quantify their lowered energy intake (LI) by simply referring to the energy contents of foods left out (not taken in).
However, to quantify raised energy expenditure (RE) one needs to take a personalised (individual) approach.
[Note: RE is deemed to be more important than LI, although both are required].

Ultimately and ideally the activity or activities producing the RE (raised expenditure) should be geared (adapted) to:
3) Improving physical fitness (cardio-respiratory endurance, muscle strength and endurance, and flexibility)
4) Maintaining lean body tissue (skeletal muscle).

500 Cal Plan
Either the plan does not exist or no one should be on it.

Satiety and Criteria for Nutritional Adequacy in Infants
A. Satiety

Looking for signs of satiety in infants (defined in ‘Nutrition in Health & Disease’ in 1968 by H. Mitchell and her colleagues as “the mechanism by which the infant is made aware that he has had enough”) is important because overfeeding in infancy may establish an undesirable feeding pattern in later life.

Unfortunately satiety (‘its expression’) varies widely among infants.
For example:
1) In some, it is sharp and is accompanied by an active resistance to further feeding attempts.

2) In some, it is less sharply defined and interest in feeding wanes gradually (after a period of playfulness).

3) Others appear not to know they have had enough and will vomit the ‘excess’.

[Note:
a) Parents, nurses, carers, etc. should be able to assess after a period of observation which category the infant they are responsible for falls under and take appropriate action.

b) In all cases feeding which includes some degree of force (compulsion, 'persuasion') should be avoided.

c) It is better to rely on the Criteria of Nutritional Adequacy (B, below) to assess that the infant is being properly fed].

B. Criteria for Nutritional Adequacy in Infants

In the publication mentioned above the following criteria for assessing adequate nutrition are mentioned:
1) A steady gain in weight
2) A moderate increase in subcutaneous (‘under the skin’) fat
3) Development of firm muscles
4) Good elimination
5) A happy infant
6) Sleeps well
7) Shows normal curiosity about surroundings

Infant Feeding (1)
Milk-related data (quantitative)

1) Human milk
a) 100 millilitres (ml) = 64 Calories (kcal) or 268 kilojoules (kJ)
b) 1 fluid ounce (28.4 millilitres) = 18.2 Calories (kcal) or 76.1 kilojoules

2) Infant formula (normal dilution)
a) 100 ml = 67 Calories (kcal) or 280 kJ
b) 1 fluid ounce = 19 Calories (kcal) or 79.5 kJ

3) Cow’s milk
a) 100 ml = 66 Calories (kcal) or 276 kJ
b) 1 fluid ounce = 18.7 Calories (kcal) or 78.2 kJ

4) Working average for (1), (2) and (3)
a) 100 millilitres = 65 Calories (kcal) or 272 kilojoules (kJ)
b) 1 fluid ounce = 18 Calories or 75 kilojoules (kJ)

5) Consumption of human milk [per pound] and {per kilogram} of body weight
respectively =
a) [2.5 ounces]-----{5.5 ounces}
b) [70 millilitres]-----{154 millilitres}
c) [45 Calories or kcal]-----{99 Calories or kcal}
d) [188 kilojoules or kJ ]-----{413 kJ}

6) Human milk production per day is about =
a) 25 ounces per day
b) 700 millilitres
c) 455 Calories (kcal)
d) 1904 kilojoules (kJ)

[Note:
a) There is considerable variation among women
b) Variation occurs also in the same woman from time to time depending primarily on the infant’s feeding rate].

7) 1 litre =
a) 1000 millilitres
b) 1.76 pints (pt) [roughly 1 and three quarter pint]
c) 35.2 fluid ounces

8. 1 pint=
a) 20 fluid ounces
b) 568 millilitres

9) 1 fluid ounce =
a) 28.4 millilitres

Recommended energy allowance (REA).

INTRODUCTION

In infancy, Obesity simplex [see definition and introduction in: “Obesity simplex (primary obesity)” posted on 7/11/ 2007] is (as it is in all other age groups) linked to a surplus of energy (unused energy that is).

It is difficult if not impossible for the carer/minder (parents, nurses, etc) to get the balance right (i.e. between energy taken in and energy expended) in the early days of an infant’s life because many factors (rapid rate of growth, activity, sleep pattern, hunger, satiety, etc.) are involved.

[Note:
1) An obese infant may be either overfed or under-active or both.

2) Overfeeding can occur because the carer (‘feeder’) cannot distinguish between a hunger cry from other crying].

3) Appropriate levels of stimulation of the infant that results in energy expenditure should be explored and encouraged].

RECOMMENDED ENERGY ALLOWANCE (REA) for INFANTS

In the 1989 publication of the National Academy of Sciences ‘Recommended Dietary Allowances’ the following figures are quoted:

a) First 6 months = 108 Calories (kcal) per kilogram (2.2 pounds) of body weight

b) Second 6 months = 98 Calories (kcal) per kilogram (2.2 pounds) of body weight

[Note:

1) A healthy infant’s birth weight:

a) Doubles after around 4 months

b) Triples after around 12 months]

Wherever and whenever possible the REA should be followed because it is linked to the body weight and therefore ‘mirrors’ or ‘shadows’ the development/growth of the infant.

EXAMPLE:

REA for James (aged 3 months and weighing 12 pounds)

Weight in kilograms = 12 pounds divided by 2.2 = 5.4545

REA = 5.4545 x 108 = 589 Calories (kcal)