The unified diet consensus recommendations by the American Heart Association, American cancer Society, American Academy of Pediatrics, American Dietetic Association and the National Institute of Health suggest that a balance diet contains 55% carbohydrates, 30% fats and 15% protein. These recommendations are American diet oriented and extrapolated worldwide. Despite suggestions that saturated fats should not exceed 10%, proposed polyunsaturated preparations may contain trans-fat (related to processing procedures to stabilize and deodorize fat) that have been related to adverse CV events. Furthermore, for two decades now, despite advisory for law fat diets (18% - 40% of total calorie fat reduction for a year) obesity remains to be problematic despite cautions that abdominal fat being related to insulin resistance maybe a precursor to frank diabetes. Replacing fats with carbohydrates (starch and sugar) or proteins (meat from animal and sea food, fishes) can also increase caloric count (food derived energy measure) and may prevent weight reduction. Low carbohydrates diets (South Beach diet, Sugar Buster or Zone diets with < 10% carbohydrates) may reduce weight at most up to 6 months and there after weight gain ensues. Controlling glycemic index (reflects elevated blood sugar levels due to rapid eating particularly simple carbohydrates such as candies, cakes, pastries, ice creams, etc) have limited evidences of effectiveness. The Mediterranean diet has at least ten components but olive oil rich diet, fruits, nuts and vegetables preferences may reduce CV risk for the compliant group but with little if at all weight reduction benefits. Vegetarian and non vegetarian diets also show no significant differences. More importantly, most diet studies involve less elderly cases with short term follow-up studies except in the Women’s Health Initiative Dietary Modification trial that involve post menopausal women with an average 7.5 years follow-up that suggested fat restriction does not reduce weight. Can this finding be translated to men?

Recent findings indicate that the brain is responsive to orosensory stimulus for palatable foods (nice to see and smell). Fasting as in inter meal gaps or diet modifications heightens the desire to eat. Could this be the explanation as to why dietary modifications do not have a lasting effect? The endocannabinoid systems (derived from marijuana initiated eating) are identified in tissues, fat cells, liver, pancreas and the brain suggesting a complex mechanism for obesity control. Endocannabinoid over expression is not seen in post menopausal women suggesting that obesity in the elderly may have a different mechanism. Antagonizing the cannabinoid over expression is currently under study. Probably curtailing the transport of fat from the gut to the liver where bad and good fats are manufactured and eventually facilitating bad fat back to the gut for elimination may be adjunctive to dietary restriction.

Having reached an elderly age, usually beyond 70 years, is an accomplishment that is difficult duplicate. In fact 70 year old patients undergoing heart checkups show that those whose BP exceeds 220 mmHg during treadmill test have less significant coronary disease on angiographic examinations compared to these whose BP is less than 200 mmHg at peak exercise. Likewise, those who are overweight with higher cholesterol levels show less CAD risk. More importantly, elderly patients prefer quality of life over quantity or years added to life. Reverse epidemiology data thus indicate longer life span for the overweight, higher BP and cholesterol levels in the elderly cases particularly among those with chronic kidney and heart diseases.

Since genetic influences in the elderly are overshadowed by endocannabinoid system polymorphism (modifications), behavioral attitudinal indiscretions and environment temptations, one’s ability to cope with any form of stress plus adequate support mechanisms are important elements to reduce heart attack risk. However, as a role model, how can an elderly tell younger household members or siblings not to gain weight, to exercise, eat properly and slowly, never smoke, if the older family member will not set the example? Thus, is being overweight a bane or a bonus? It is up to you, isn’t it? May I suggest that if you are currently in good health; continue with your current life style. If you are under the care of a doctor, follow his recommendations. He should know better, if he does not agree with the above statements, just shut up. You will need him more than follow blindly a broad sheet story. “Weather, weather lang ang buhay.” But as boy scouts would say “Be prepared.”