continuing our amazing series of articles from Dr Paul Batman PhD.

Remember you can use these for your own clients and in your own social media. 

16. Are you sure that I have high Cholesterol?

I recently had a blood test to measure my cholesterol levels. Fortunately my LDL (bad cholesterol) levels were within normal limits but to my surprise my concentration of HDL (good cholesterol) waslow.

This alarmed me, as a trigger for the elevation of HDL (good cholesterol) is being physically activity.

How could my good cholesterol levels be so low given that I have been so active all my life?

Armed with this anomaly I decided to investigate further to see if high LDL (bad cholesterol) levels were as damaging as reported.

It has been stated for years that fat intake plays a significant role in causing heart disease and more specifically high cholesterol.

Stains and High Cholestero

Mny of us have been prescribed Statins to control our LDL cholesterol (Low Density Lipoproteins) levels when they are high. These types of drugs have become the most heavily prescribed medication in the pharmaceutical range.

It has also been prescribed as a prevention to combat high cholesterol

There is now a big question mark over whether increased saturated fat in our diet is responsible for the increased prevalence of heart disease and increased cholesterol levels. New information suggests that the culprit could be abnormal carbohydrate ingestion rather than too much fat in the diet.

Diet and Cholesterol

This would suggest that high carbohydrate diets could be playing a role in increasing the LDL concentration (bad cholesterol) while decreasing the HDL concentrations (good cholesterol) all of which appear to be reversed in a high fat diet.

The general consensus is that an increase in LDL cholesterol is detrimental to our health. A friend of mine recently was concerned that his cholesterol level was approaching 10 mmol/L and was worried about the consequences.

But is it as simple as that?

Does merely having a high generic LDL cholesterol count and a low HDL cholesterol count predispose us to cardiovascular disease?

We now know that three different types of LDL cholesterol based on size (low, medium and large particles).

Does size matter?

We also know that it is the small particles of LDL that are now considered the main risk factor in heart disease. The larger LDL particles apparently have little or no effect on CV disease.

To tip current thinking on its head there is a school of thought that a high carbohydrate diet can cause an increase in the production of small LDL particles, whereas a high fat diet causes an increase in large LDL particles.

Siri, Tarino, Hu, Sun and Kraus in their seminal paper stated that “Saturate fat, carbohydrates and cardiovascular disease reported that a high fat diet can improve blood fat components based on the size of the LDL particle”.

When prescribed “statins” to control high cholesterol how many times has a patient’s LDL cholesterol particles ever been measured?

It could very well be that there are many people out there who are on statins to regulate high cholesterol that do not need to be treated with this medication as they may have healthy large LDLs as the major component of their cholesterol profile.

Perhaps a better indication of our cardiovascular health would be our fasting glucose levels, insulin and hemoglobin A1c concentrations given the possible role that high carbohydrate diets have in elevating small LDL particles.

We need to question..

It seems that prescribing “statins” for people when their cholesterol levels exceeding 5 mmol/L without knowing their small particle LDL concentrations could be questionable at best and in need of urgent review…..

17. Is travelling economy class really worth it……?

Recently I was on a flight home from holidays seated in row 20B between two people that I didn’t know. I sat there while the flight attendant reminded us that there was an information leaflet in the seat pocket we should read to avoid DVT (Deep Vein Thrombosis). It sounded more like a sexually transmitted disease than a condition where blood clots develop in your veins if you sit in a cramped position for too long. To make it worse it can lead to strokes and heart attacks.

The leaflet highlighted the importance of low-level muscle activity and stretching and low-level movements of the body to increase blood flow on a regular basis during the flight to avoid these life-threatening conditions.

All I wanted was to buy a ticket on a plane to get me home, not to suffer some life threatening condition where the possibility was I wasn’t even going to make it home!! I didn’t realize that sitting in a seat could have just dire consequences. DVT has been tagged “economy class syndrome” due to the restricted area that travellers are forced to sit in and where little movement is possible in plane seats.

The medical fraternity is now recognising that too much sitting and not enough movement during prolonged periods of inactivity can cause DVT irrespective of whether you are sitting on a plane in economy class or not.

Reports suggest approximately 600,000 Americans are hospitalized every year with DVT complications that can cause death. DVT symptoms can develop rapidly or over a period of time and can include warmth, redness or discolouration over the calf area. It is possible to have no visible signs or symptoms.

Many of these DVT problems are now being identified in people watching excessive amounts of TV, using computers and continually playing computer games as well as those sitting for long periods of time in specific occupations, travelling to and from work or in other leisure type activities.

In a study conducted in New Zealand of 62 people who were hospitalized with blood clots, 34% were reported to have occurred from prolonged sitting at their desks. The problem of DVT was particularly prevalent in occupations such as information technology and call centres.

In the current work environment many employees are now working longer hours, spending more time at their desks, not taking breaks and even eating their lunch while still sitting at their workstation placing themselves at risk of DVT.

Recommendations to avoid DVT include avoiding long periods of sitting by standing every hour or walking around the office, being physically fit, wearing compression garments, remaining hydrated and reducing obesity levels.

18. What is our preferred form of fuel?

The current dietary recommendations suggest that our diet should be broken up into proportions of 50% carbohydrates, 30% fats and 20% proteins.

An interesting collaroy to this break up is that the various cells of the body do not all partition food as per this recommendation. There are some cells that prefer to use fats or carbohydrates exclusively while others are so specific that they require different combinations.

Skeletal Muscle

Our skeletal muscle cells that are responsible for all human movement prefer to use fats as their main source of fuel at rest. These cells only use glucose when insulin levels rise and the increased blood sugar needs to neutralised and stored as glycogen or fat.

During any movement at intensities less than 60% of our maximum effort our body will use fats as fuel. Above 60% of maximum effort our muscles begin to use glucose and as the intensity increases glucose use will become more dominant.

As the intensity of our effort increases, the glucose that is mustered for use is broken down in the absence of oxygen causing an increase in lactic acid. This would indicate that our effort has now moved from an aerobic activity to an anaerobic activity or a combination of both.

We know that an increase in lactic acid is often blamed for the increase in fatigue.

The lactate component is sent to the liver where it can be reconverted back to glucose while the hydrogen ion component is the culprit that changes the acid concentration of our bodily fluids resulting in a breakdown of other cell functions throughout our body.

The Heart

The heart prefers to use fat when you are not moving intensely. It is a rare occasion when the heart uses glucose (carbohydrates) as its main fuel source.

During high intensity movement a healthy heart will pick up the lactate from the lactic acid produced throughout the body to produce energy to maintain its contractility. In fact, the heart will prefer to use the lactate rather than glucose during high intensity movement. It is ironic that the heart would prefer to use its by-product rather than the main carbohydrate component.

The Liver

The liver is an important player in the storing, making and release of glucose when required. When carbohydrate levels are low the liver collects and secretes fatty acids while forming Ketones as well as making and releasing a number of important blood proteins. The liver is a key organ that is responsible for many important functions while predominately using fats as its key source of fuel. The fat needed for this function comes from fatty acids released from adipocytes (fat cells) or from making fat from stored carbohydrates.

The Brain

The brain is most selfish organ in the body. It must be fed first and has preference over the other organs. To produce energy it can burn carbohydrate, fats or Ketones depending on the environment.

The brain weighs approximately 1.5 kilograms and can use up to approximately 600 Kcal per day! This is way more than any other organ in the body. The extensive blood supply to the brain is crucial to producing this amount of energy as well as maintaining its optimal temperature.

It is true that the brain, based on our dietary recommendations, is very dependant on carbohydrates for its fuel. It doesn’t have any reserve of glycogen as the muscle does so when blood sugar levels are low initially there is an increase in heart rate, hunger, tremor and fatigue.


The brain is very well placed to use ketones as it has many fatty membranes and myelin sheaths that surround the cells and nerves. The brain also contains numerous mitochondria, which are also very capable of metabolizing ketones or fatty acids. The liver through the oxidation of fatty acids produces ketones.

As a consequence there is an increase in the release of adrenaline from the adrenal glands that controls the breakdown of any glycogen in the liver as well as the formation of any glucose from any circulating lactate.

In the event that carbohydrate levels are low (between 200-600 Kcal per day) or reduced by intense exercise, the liver looks for another source of fuel for the brain. It chooses to convert fatty acids to ketones.

An increase in ketones for energy for the brain occurs in low carbohydrate environments and after or during intense exercise. Ketones concentration between 1-3 millimolar (MM) is within a healthy normal range.

Some dietary recommendations state categorically that the brain is a carbohydrate dependant organ.

This only appears to be the case when we are on a high carbohydrate diet. This would perhaps challenge the idea that nutritional ketosis (using ketones rather than carbohydrates) is counter productive for the brain, when in fact it could be very productive given the significant amount of fat stored within the body.

A process that encourages the brain to use ketones and other organs to use fatty acids rather than glucose could potentially have very beneficial effects in weight loss and general health.

The question is now:

“ Given that the body’s reserve of carbohydrates is limited (up to approximately 2,000 Kcal) and the fat reserves extensive (approximately 80,000 Kcal) could a keto-adapted eating plan (lower carbohydrate, more good fat and moderate protein eating plan) allow our body to burn more fat as a fuel for the majority of our bodily functions without impairing any brain function?”

Is it time for the healthy food pyramid to be challenged as our best recommendation for optimum health given that the partitioning of the macronutrients doesn’t always match the body’s energy requirements?

Albert Einstein once said that the definition of insanity was to continually do the same thing over and over again and expect a different result each time.

We might be getting to that stage….

19. 10,000 steps… you must be joking

Many weight loss programs are based on the “No Pain, No Gain” theory that requires a maximum physical effort for a long as possible. The aim is to expend or use as many Kcals as possible. While some of these programs experience some success they can also produce side effects that often outweigh the weight loss.

One exercise prescription used in weight loss programs and for general health improvements is walking 10,000 steps per day. It is prescribed in weight loss because of its moderate intensity and longer duration benefits.

Most eating plans for weight loss recommend some carbohydrate reduction. If the accompanying exercise recommendation is high intensity exercise the client can quickly fatigue due to the lack of fuel used for this activity.

The 10,000 steps preserve the carbohydrate fuel stores and uses fat as the main fuel for the activity. Given that the eating plan is what will predominately contribute most to the weight loss the physical activity prescription has to be realistic and sustainable.

We know that obesity often results in a mild inflammation that increases the activation of elements of the immune system such as macrophages, lymphocytes and cytokines. This places additional stress on the immune system to not only fight normal infections but to also control the obesity side effects.

In some cases high intensity exercise has the ability to contribute to the bodies already inflamed obesity state potentially causing additional harm to the cell membrane of many other tissues.

If high intensity exercise is used for weight loss, clients must have previously progressed through the earlier levels of intensity in order to prepare the body for the increased fatigue and side effects that it will cause.

Energy Expended

For adults the 10,000 steps approximates to a distance of about 8 kilometres and has the potential to burn between 300-400 Kcal depending on body size.

To give the 10,000 steps some perspective, most people in their general daily routine walk between 4,000 to 6,000 steps per day resulting in a general daily deficit of about 4,000-6,000 steps in meeting national recommendations.

There are some sedentary people that do not even walk 2,000 steps.

The minimum number of steps to be completed for any strong positive change to occur is 7,500 steps.

For the intensity to be classified as “moderate intensity” it is recommended that we walk at a 100 steps per minute. This translates into approximately

1,000 steps per 10 minutes, which has a moderate metabolic equivalent or at an approximate speed of 5 kilometres per hour.

At 1,000 steps per 10 minutes the 10,000 steps would be completed in less than 100 minutes.

The 10,000 steps should be included with or within your incidental and active living activities. The duration for 10,000 steps to be completed is generally between 60-100 minutes depending on the speed of the steps.

The 10,000 steps can be completed at any one time or over periods of time during the day.

As an alternative to counting the 10,000 steps we can complete 60-100 minutes of continual or intermittent walking or walk for a total distance of 8 kilometres continually or intermittently.

During periods of progressive overload it is recommended that no less than an additional 250 steps per day be recommended at any one time in order for us to build up to the 10,000 steps per day. The steps per day can also be taken in 10 minutes bouts to meet the desired goals.

If we can’t start at 10,000 steps begin at a level that we can maintain and slowly overload until we feel confident of going to the next level eventually reaching 10,000 steps.

To give some comparison, a typical 30 minutes exercise session of moderate intensity is approximately equal to an energy expenditure of 150 Kcal.

Attempts have been made to classify activity levels according to the number of steps completed in a day.


Steps                                                                                                       Classified

<5,000 steps                                                                                           Sedentary

5,000-7,499 steps                                                                                  Low active

7,500-9999 steps                                                                             Somewhat active

10,000-12,500                                                                                          Active

>12.500                                                                                                 Highly Activ

Normal healthy active adults generally walk between 7,000-13,000 steps per day. Children are reported to walk 11,000-13,000 steps per day.

In a study conducted in Japan a group of diabetic subjects who completed 19,000 steps per day lost on average 7.7kg over a 6-8 week period compared to 4kg lost by subjects who dieted only and averaged approximately 4,000 steps a day.

It is becoming more apparent that a dose response approach to a “steps per day “ is most effective for different populations. For example, improvements in depression begin to appear in individuals who complete approximately 7,500 steps per day while changes in body composition require a much higher daily step count.

Another study reported sedentary workers in an intervention program consisting of walking by counting steps achieved a large decrease in waist circumference.

One Danish study reported that the active workers who walked more steps gained less weight than their sedentary counterparts.

Perhaps the most impressive results of walking are amongst the Amish people of North America. Their simple non technology, non automated lifestyle requires them to walk approximately 18,425 daily steps for men and 14,196 for women mainly accumulated from Monday to Saturday, as Sunday is a day of rest.

It was very rare to find an Amish person who did not walk at least 10,000 steps per day.

The high level of lifestyle physical activity of the Amish people contributes to them having the lowest prevalence of obesity and overweight in North America.

Bottom Line

The message is to stay on our feet and keep on walking for as much of the day as we can..

20. What if I can’t do 10,000 steps?

The 10,000 steps prescribed for weight loss or aerobic fitness has been validated many times to be both effective and reliable and correlates well with aerobic fitness. It is simple in that everyone can walk, it is cost effective, burns an adequate amount of energy, easy to remember and gives us a definitive goal.

It is beyond debate that there should always be a physical activity component included in all weight loss programs. Not so much to make a huge contribution to energy expended but to also provide major health benefits that even weight loss might not provide. The physical activity only needs to be performed at low to moderate levels of intensity, so we are not talking about high intensity fitness activities or gym activity alternatives.

Clients most surely want to lose weight but at the same time they also want to improve their health. What better way to achieve this than starting a sensible eating plan and using walking as the main form of physical activity.

But what happens if for some reason we can’t walk or don’t want to walk, what is our destiny?

Do we continue to sit while planning, preparing and eating our food or is there an alternative.

Remember that there are very serious issues to contend with by sitting too much, even in the presence of major weight loss. Sedentary people spend on average up to 10 hours a day at the lowest level of metabolism.

I was in a similar position sometime ago. After surgery I had difficulty in continuously walking although my knee was quite strong.

So I decided to look for alternatives to walking 10,000 steps.

I thought long and hard as to how could I equate any other movement to the 10,000 steps model.

I decided to calculate the number of Kcal expended in 10,000 steps and then see if I could equate it with other activities I do around the house.

I weight 80 kilos and am 179 cm tall. I calculated that an 80 kilograms person in walking 10,000 steps (which is approximately 8 kilometres) would take 80 minutes if walked at 6 kilometres per hour.

OK sounds good but what if I walked faster at 8 kilometres per hour to cover the 10,000 steps in 60 minutes?

I calculated that if I walked at 6 kilometres per hour I would expend approximately 370 Kcal in walking for 80 minutes.

I also calculated that if I walked at 8 kilometres per hour I would expend 378 K calories in walking for 60 minutes.

What could I do around the house without going anywhere and expend the same amount of Kcal that I would get from walking 10,000 steps.

I decided to calculate how much energy (Kcal expended) it would take to sweep the floor, sweep the garage, rake the leaves, mow the lawn and carry some bricks that I had to move around the garden.

So I swept the floors of the house for 15 minutes, swept the garage for 15 minutes, raked the leaves in the garden for 15 minutes, mowed the lawn for 30 minutes and carried bricks from one spot to another for 60 minutes.

To my amazement I calculated that I expended 70 Kcal sweeping the house, 84 Kcal sweeping the garage, 84 Kcal raking the leaves, 189 Kcal mowing the lawn and 672 Kcal carrying and moving bricks from one place to another.

The total number of Kcal I expended in 2.50 hours was 1,099 Kcal by just completing household activities.

If I go back and just equate my household activities with the time to complete 10,000 steps I would have completed these tasks (sweeping, raking, mowing) in 75 minutes and expended 427 Kcal in comparison to expending 370 Kcal walking 10,000 steps at 6 kilometres per hour or 380 Kcal walking at 8 kilometres speed for 60 minutes.

How can this be?

In all my household activities I used both my arms and legs with the additional movements of bending, striding, picking, pushing, squatting, lunging etc.

These additional movements produced greater energy expenditure than walking alone.

I think that 10,000 steps is an excellent exercise prescription that is universally accepted as a legitimate form of physical activity for weight loss and general fitness.

However, there are some people who might find it a little too daunting, unsafe, time poor to commit to walking the 10,000 steps, etc. Now there is an alternative for them as well as giving the 10,000 step walkers the chance to move more and burn more energy!!

This teaches us never to underestimate the energy expended in life style movements as a legitimate player in the weight loss and health equation.

Making a choice to include lifestyle physical activity into our weight loss journey in combination with our 10,000 steps is a great opportunity to use heaps more additional energy that can contribute to our weight loss goal.

Additionally just think of the money we will save by sacking our house cleaner and gardener and doing the work ourselves!!

21. Can I drink alcohol while on a weight loss program?

I always like to go home at night put my feet up for a few minutes and have a beer just to finish off the day. I never drink too excess but find that one beer every now and again makes me feel good.

Is this because I really want to drink that beer or have the alcohol companies hoodwinked me into thinking this?

Can we afford the luxury of a few alcoholic drinks if we are on a weight loss journey?

People often say “I am getting fat because of the extra Kcal that is in the alcohol” or “I would rather drink my Kcal than eat them”.

What is the real reason why more than light drinking of alcohol can sabotage our weight loss journey?

What do we know? We know that

An alcohol drink contains about 15 grams of ethanol alcohol

15 grams of alcohol is found in 5 ounces of wine, 1-1.5 ounces of spirits such as vodka and whiskey

15 grams of alcohol is in 12 ounces of beer

Every gram of alcohol counts for approximately 7.1 Kcal

So when I got home last night I drank 15 ounces of beer (20 grams of alcohol) with dinner. The number of Kcal I consumed was 7.1 x 20 grams = 142 Kcal. This about average Kcal per glass of alcohol irrespective of the form it takes.

Obviously mixed spirits that contain additional soft drinks would be even greater again.

While the extra Kcal is important it just does not stop there…. What happened to the alcohol once I drank it?

My body quickly recognised that the alcohol needed to be eliminated from my body. It released a specific enzyme used to break the alcohol down to acetate, which is highly reactive especially in the liver.

My body is getting worried that these by-products are dangerous and decides that the best way to get rid of it is to use it as fuel as soon as possible rather than store it.

At the same time my body begins to stop any carbohydrates from being used as energy. It also blunts my fat burning capabilities by 80% after only one-two drinks.

Very little of the alcohol that I have been drinking will be stored as fat and will be quickly modified to be used as fuel while the carbohydrates and fats that my body has been previously using as fuel for energy will now be stored as fat for use at a later time. This cannot be good!!

My liver is working tirelessly to neutralize the alcohol with the aid of many vitamins and folate.

After a couple of drinks my brain increases an inhibitory neurotransmitter and makes me feel a lot more relaxed. This is paradoxical as my body relies on more of this neurotransmitter to go to sleep. Now that my brain has been using more of it than usual because of the extra alcohol, I don’t have enough of it to help me remain asleep. I get up in the middle of the night interrupting my diurnal rhythm and normal hormonal release.

This neurotransmitter is critical for the brain to help me have a restful night’s sleep.

Drinking in excess sometimes results in behaviour that is totally out of character for some people. This is mainly due to the higher processing centres of the brain called the cerebral cortex now being down regulated in response to the additional alcohol putting me in a depressed state.

We know that when we drink we also go the bathroom more frequently. This is due to the release of a hormone responsible for regulating my fluid balance and assisting in removing the alcohol from my body as soon as possible. My kidneys are now working overtime to get rid of the alcohol as well as some minerals and electrolytes are lost as they are released to help keep my body in balance.

If the fluid loss becomes too great I will then become dehydrated, have a massive headache that will take me a couple of days to recover.

If I continue to drink above the normal recommendations on a daily basis the breakdown of alcohol continues on a regular basis permitting less glucose to the brain and muscles making me tired andlethargic.

In summary, alcohol can sabotage our weight loss on many levels. It can force our body to store more fat and carbohydrates, cause dehydration, interrupt hormonal activity and stop us from having a good nights sleep.

It can also create obstacles in maintaining our movement program, affect our motivation and commitment to weight loss, change our sleep patterns that are so important for hormone regulation and recovery.

If you are drinking more than a couple of alcoholic drinks per week and also trying to lose weight, it is now the time to take stock of what you really want and either give up the weight loss goal or the excess alcohol.

Your choice ?