Metabolic syndrome in Asians

A few years ago, I started having trouble with high blood pressure and cholesterol.  The good cholesterol was low, the bad cholesterol was bad, and the triglycerides were going up.  My blood sugar was also a little bit worryingly high.  At the time, my doctor said I was doing everything right; diet, exercise and weight (I was obviously skinny – by American standards), and that my metabolism going all wrong was “just genetics.”  He said that at some point soon, I would have to start taking medication to control it.  Because my father has the same sort of problems, I figured that he was right.

That sort of statement – “Just genetics” is a tough thing to hear, because it suggests that there’s nothing you can do about it.  However, a few months later, I happened to read a scientific article [1] that said that some Asians start having trouble with their metabolism with a Body Mass Index (BMI) as low as 22.  At the time, my BMI was exactly 22, and it got me thinking.  What would happen if I lost a few pounds?  I recalled an uncle who suddenly lost 20 pounds after being hospitalized for a stroke, and among other surprises, his diabetes went away.  Was that just a fluke, or could it be a clue to something that might work for me?

I decided to lose three pounds to see what would happen.  I chose the number three because my weight varies about that much over the course of a given day.  I would normally weigh about 147 lbs in the morning, and about 150 lbs at the end of the day before going to bed.  If I lowered those limits to 144 lbs in the morning, and 147 lbs at night, then it would be about the smallest measurable weight loss I could accomplish, but it would put my BMI at 21.7.

It took about a month to lose the weight, and I was pretty unhappy about it the whole time. I held the same weight range for the rest of the year, and then I went and got all of the same tests done at my next annual checkup.  While there was no meaningful change in my blood sugar, the blood pressure and cholesterol were all great.  They were as good as they had ever been when I was younger and ridiculously athletic.

I had thought that maybe it was age.  Maybe it was not being physically able to tolerate the amount of cardiovascular exercise I used to do.  Then there’s the genetics.  But losing a little weight was a relatively simple, non-pharmaceutical and not-so-stressful way of achieving the same healthy blood pressure and cholesterol levels.

Subsequently, I decided to lose an additional 3 lbs. That’s just because it’s too easy to gain 3 lbs over the course of a vacation, and I wanted a little bit of wiggle room before having to worry about my blood pressure and cholesterol.

I suspect it would work well for the blood sugar if I were willing to put the weight loss in combination with a low carbohydrate diet, but as an Asian, I really like my rice and noodles.  It’s also possible that an even lower weight threshold might take care of the blood sugar.  It may be in the cards for me in the near future, and I will update if I decide to go low-carb or lose another three pounds.

I think the take home lesson is that if you are an Asian experiencing any sort of metabolic control problem, such as cholesterol, blood pressure or high blood sugar, one of the first things you should consider is getting your BMI under 22.  It seems that some of us might be genetically wired to be healthy at a lower weight than comparable non-Asians.  Also, it’s possible that 22 might not be a magic number, as more recent research suggests that Asians can get in trouble at an even lower BMI [2].

Maybe my doctor was right about it being genetics.  However, maybe it’s genetics and there’s still something you can do about it.

Vacation notice

I will be out of town for two weeks starting August 26, 2019.  I will be back in the clinic on September 9.  Please feel free to click on the green appointment button to book a treatment for when I return.

All moved in

Everything is moved into the new office at 4101 Greenbriar Dr.  The clinic will re-open tomorrow, March 2, 2018.  Come check out the new space!


New location

Kao Acupuncture is moving to a new location on March 2!  The new building is a medical office building located at 4101 Greenbriar Dr, just 0.7 miles from the previous offices.

The new office has ample parking on three sides of the building,  It was also completely renovated in 2014 and offers comfortable seating throughout the first floor atrium and lobby.

Kao Acupuncture will be located in Suite 105B, just off the central elevator atrium.


Shoulder and neck pain? Check these muscles

For many patients who are experiencing chronic shoulder pain at the top of the shoulders, leading into the neck, there are three main sets of muscles that are likely to be tense.  These muscles tend to be tight as a result of stress or poor posture (frequently due to poor ergonomics when working at a computer).  Learning to stretch these muscles and to periodically check they are in a healthy position, especially when working under stressful conditions, can be very helpful in minimizing this type of shoulder and neck pain.  An acupuncture treatment can help relax these muscles to alleviate much of the pain, but learning good posture is critical for preventing the problem from recurring.

The first and most obvious muscle is the upper portion of the trapezius, which extends from the base of the skull to the outer edge of the shoulder.  Flexing this muscle causes the outer portion of the shoulder to rise.  Second is the levator scapula, which extends from the upper vertebrae of the neck down to the inside top corner of the shoulder blade.  Flexing this muscle causes the inside part of the shoulder blade to rise.  The third set of muscles are the scalene muscles, which connect the neck bones to the upper ribs, and assist in respiration by lifting the ribs a little bit.  Most people don’t have a lot of conscious control of the scalene muscles.

If all three of these muscle groups are tight, then your entire shoulder is elevated (which makes your neck look shorter than it really is, and makes your shoulders look square), and it may be a little bit hard to take a deep breath.  If all of these muscles are chronically tight and knotted, severe neck and shoulder pain are not far behind.  Unfortunately, stretching these muscles to alleviate the tension and pain is difficult.  If you attempt to stretch the muscles on one shoulder by tilting your head, it’s difficult to avoid aggravating tension in the same muscles on the opposite side.

Now consider the Venus de Milo.  Like many ancient Greek statues, her neck appears very long and elegant.  This posture comes from elevating the head while lowering the shoulders.  To get into this position, the woman who modeled for the sculptor must have had relaxed muscles throughout her upper shoulders and neck, and we can presume that at least at that point in her life, she didn’t have any pain in that part of her body.

The stretch I recommend is to imitate the appearance of the Venus de Milo’s neck in several steps.

  1. Hold a light weight such as a one pint water bottle or small barbell in each hand, and let your arms hang at your sides
  2. Elevate your head up as high as you can
  3. Allow the weight of the water bottle to pull your shoulders down.

Hold this position for perhaps 30 seconds, until the neck appears longer (indicating that the levator scapula and scalene muscles are elongating) and until the shoulders angle downward on the outside (indicating that the trapezius muscle is elongating).

I would suggest doing this stretch preventatively if you have a profession that requires a lot of sitting at a computer desk, or if you have any sort of job which requires holding your arms up for prolonged periods, e.g. driving.

One other hint is to be careful of the types of bags you hang on your shoulders.  If you carry a satchel or purse on one side, using a single strap on that same-side shoulder, you may be unconsciously elevating your shoulder to prevent the bag from sliding off.  People who have shoulder and neck pain should avoid using this kind of bag.  Instead, use a double strap backpack (which can also help you do the Venus de Milo stretch), or use a courier type strap which extends over the neck to the opposite shoulder, switching sides periodically to avoid lopsidedness.

Eating more fresh fruit to lose weight

I would guess that the typical American isn’t getting enough fruit in his or her diet, and this is a big contributor to the obesity epidemic in our country.

Current dietary guidelines recommend that at adult get about two cups of fruit per day (on a 2000 Calorie diet).  Most fruits also have a low glycemic index, which makes them a good healthy food choice for diabetics, even though fruits do contain sugar.  This is because they also tend to be high in fiber, which helps slow absorption of sugar and moderates how fast blood sugar rises.  (Also, fiber is good for you and the fruits are loaded with vitamins.)

So what exactly does two cups of fruit mean?  A typical medium-sized apple or orange is about one cup of fruit.  Are you eating an entire apple and orange every day?  I do on some days, and it feels like a lot.

One of the most important qualities of fruits is that they have a very low calorie density.  What this means is that for the amount of calories (or sugar) that is in a piece of fruit, it tends to take up a large amount of space in your stomach.  Since fruit is also high in fiber, it tends to stay in your stomach for a long time, because your stomach has to grind it up before it can pass on to your intestines.  This means that fruit can be used as an important substitute for unhealthy foods.  You eat the fruit, and it makes you feel full.  That keeps you from eating too much of something regrettable.

Recommended approach: Substitute some of your usual food with fruit

Here’s how this might work.  Suppose I normally eat two slices of pizza at dinner and follow it up with two scoops of ice cream.  What I could do is instead eat one apple before dinner, and then limit myself to one slice of pizza and one scoop of ice cream (if I still have room for it).  By making a substitution like this, I can reduce my calorie intake by almost half, and still feel full after dinner.

I would say that any trick which can help you cut your calorie intake by half, but not result in you feeling hungry, could be the difference between losing weight and gaining weight very quickly.

To maintain my weight at my typical level of exercise, I need to have about one quarter of my food to be fruit.  If I’m trying to lose a few pounds, I need to increase my fruit intake to about half of my diet.  If I get lazy and stop eating fruit for a few days, I start to gain weight.

One important suggestion is that eating slower can really help increase the impact of this technique.  If you eat the fruit and then follow it with the “healthy” portion of your meal, you should consider waiting a little while before you think about dessert.  A delay of maybe only 20 minutes can allow your brain to catch up to your stomach, so you realize how full you are, and you can eat less dessert or skip it altogether.

The “Crazy” approach: Add a weight cap

People have been asking me how I’m still skinny at the age of 43, even though many of the elders in my family are struggling with their weight. (In other words, me being skinny is not genetic.)  Because I’ve seen loved ones struck down by diseases that are compounded by poor diet, high blood sugar and obesity, I am kind of crazy serious when it comes to not gaining weight.

I have a hard upper limit on my weight.  I don’t recommend this approach to everyone, because it requires kung fu discipline (which basically means you consistently do something difficult despite suffering, because it’s important).

I weigh myself several times each day.  If my weight is over 148 pounds (chosen because it’s a safe BMI for Asians to avoid diabetes), then I stop eating.  After that point, I am only allowed water or fruit.  If I am craving protein, I may allow myself an ounce or so of pecans or other nuts.  The fruit contains very few calories.  The water contains no calories, and if I eat nuts, it’s not very much of them. The fruit makes me feel full, and the nuts add a level of satisfaction.  I suffer a little bit, but barring a major metabolic problem like liver or thyroid disease, it’s more or less impossible for me to gain weight with this approach.

Given that I’m eating fruit for the remainder of the day, and only consuming fluids, the extra weight that is keeping me over 148 pounds is always gone the next morning, digested away and excreted as urine.  (I normally start the day at about 146 pounds.)

Obviously, I don’t do this on special occasions, like holidays or vacations.  If I’m out on a dinner date, I can’t run home and weigh myself before dinner, so I just eat like a normal person.  However, on your typical week, I am restricting myself on about six of the seven days of the week.  Do I feel deprived sometimes?  Yes, I do.  But I also don’t worry about diabetes, which to me is worth it.

Herb tincture


One of the more interesting ways of taking an herb in Chinese medicine is the topical tincture.  Herbs are soaked in liquor for a period of several months. The liquid is filtered and applied to the skin for a variety of conditions.  The advantage of applying a medicine topically to an affected area is that compared to drinking an herbal concoction, there is less risk of adverse systemic affects, such as allergies or interactions with other medicines.  This particular mixture is modified from a traditional formula used by martial artists to help them recover from the constant injuries they suffered as a result of their strenuous physical conditioning.