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Body composition, phase angle and patient health – Part I

BIA can measure muscle mass, fluid, or fat gain or loss and bring phase angle, or 'true age' and health into perspective...

BIA can measure muscle mass, fluid, or fat gain or loss and bring phase angle, or ‘true age’ and health into perspective

As a biohacker I like using simple measuring devices and tests for personal health information that keeps track of my total sleep time, REM sleep, deep sleep, resting heart rate, heart rate variability, body temperature and more, and BIA and phase angle are part of that.

In my office, using a weight scale and a bioelectrical impedance analysis device is up there with the blood pressure cuff and pulse oximeter. Certain measurements I want on every patient.

Bioelectrical Impedance Analysis (BIA), a method of assessing your body composition and measurement of body fat in relation to lean body mass, is an integral part of a health and nutrition assessment. It may be used to assess:

  • Body composition (estimate)
  • Fluid balance/distribution
  • Cellular performance (cellular health analysis)

The information it provides such as body composition, fluid distribution and phase angle help guide many of my treatment decisions. This test can be performed as often as necessary to document changes in body fat, lean muscle mass and phase angle. There is a code — A4556 BIA Electrodes (2 sets @ 15 each) — to bill and charge for the test/service.

Bioelectrical Impedance Analysis for health and longevity

BIA is a non-invasive, inexpensive and quick method to estimate body composition. Helping patients lose fat weight is something I particularly enjoy because obesity reduces a lifespan by 8-20 years.

Improving a person’s body composition is a health and longevity upgrade. One of the most interesting discoveries of my career has been the recognition that adipocytes (fat cells) produce inflammatory cytokines. Many patients come in complaining of multiple joint aches and pains; often these patients are 5-10% overweight, and this contributes to low-grade systemic inflammatory disease.

Their joints are “smoldering” and need anti-inflammatory care. The “overweight epidemic” led me to hire a full-time person for fat loss, which complements my musculoskeletal rehab practice. My chiropractic practice includes:

  • Making healthy food choices
  • Preventing chronic disease formation
  • Improving body composition
  • Reducing body fat storage
  • Increasing lean muscle mass
  • Reducing inflammation
  • Improving blood sugar management
  • Reducing hyperinsulinemia and hyperglycemia
  • Increasing exercise and physical activity via gentle movement therapy and strength training to prevent sarcopenia (loss of muscle)

If a patient has excess fat, I let them know it is detrimental and may be contributing to the way they feel.

Body Mass Index (BMI)

BMI is commonly used as an index of body composition; however, it is not useful for measuring percentage of body fat or lean body mass. Patients with normal BMI may have sarcopenia or sarcopenic obesity.

“Weight and BMI do not evaluate body compartments and therefore do not reveal if weight changes result in loss of fat-free mass or gain in fat mass,” (J Amer Diet Assoc 2002;102(7):944-955). However, BIA is a reliable resource for assessing body composition, hydration status, tissue differentiation and cell membrane integrity, providing instantaneous in-office information.

Why is body composition and BMI associated with increased risks? Because muscle mass is the #1 biomarker of aging.

Hence, the higher the muscle mass the greater the longevity. Maintaining muscle mass is important for healthy aging and preventing:

  • Sarcopenia
  • Obesity
  • Heart disease
  • Type 2 diabetes
  • Osteoporosis

Measuring muscle mass improves patient motivation to put it on.

On a cellular level, increased capillary permeability and disturbed cellular membrane metabolism (seen in septic patients) are responsible for extensive shifts in body fluids, expansion of interstitial space and abnormal hydration of the lipophilic part of the cellular membrane.

A rapid change or inconsistent alteration in BIA test results may be due to hydration status, technical problems, or an effect from physiologic events (e.g. menstruation, irregular eating, exercise, skin temperature, etc.). Therefore, with repeat tests I try to do them around the same time and same day of the week. Tests can easily be performed on a weekly basis.

Resistance

Resistance is related to the body fluids (water and electrolytes) primarily in lean body mass (high-conducive, low-resistance pathways). It is the opposition of total body water (fluids) and electrolytes contained primarily in the body lean mass to the flow of an alternating current of low amplitude and high frequency (800 uA and 50 KHz).

Resistance will change according to hydration status and is a reliable tool for accurate fluid management (Surgery 1992; 112:502-508); (Clin Nutr 2004;23:1430-1453). The higher the resistance, the greater the dehydration and muscle wasting for those with a low percentage of body water in their reduced lean body mass. A major decrease in resistance is interpreted as a great fluid retention. In a hospital setting among septic patients, those who develop renal failure and positive fluid balance display a direct relationship between body fluid gain in morbidity and mortality (J Ren Nut 2016:26:391-395).

Reactance

Reactance is the capacitance produced by tissue interface and cell membrane. Cell membranes consist of a layer of nonconductive lipophilic material interposed between two layers of conducive molecules.

Progressive reductions in resistance and reactance over successive measurements indicate fluid overload with positive fluid balance; a progressive increase indicates negative fluid balance (Piccoli et al 1995, Ho LT et al 1994).

Phase angle

Phase angle is the ratio of reactance/resistance. Phase angle has been utilized to discriminate between normal subjects and patients, and between septic and non-septic critically ill patients. It indicates alterations in either body composition or in cellular membrane function.

Phase angle varies between 3-15 degrees (the average is 5-7). In all of the hundreds of tests I have done over 25 years I rarely see anyone above 10. A low phase angle number (<5) or an unchanged value during a course of treatment suggests the treatment or care is not on the right track.

Ott, et al. (1995) used phase angle as an important parameter for monitoring disease progression. Because it is a marker of how resilient the receptor sites are, with cells either living or dying, phase angle has even been used on HIV patients and critically ill patients to monitor progress; increased capillary permeability and disturbed cellular membrane metabolism (seen in septic patients) are responsible for extensive shifts in body fluids, expansion of interstitial space and abnormal hydration of the lipophilic part of the cellular membrane.

Cell membranes

Cell membranes consisting of a layer of nonconductive lipophilic material interposed between two layers of conducive molecules behave as capacitors and generate the reactance that reflects alterations of the complex membrane integrity.

I’m no electrical engineer, but I see how reactance, capacitance, cell membranes and phase angle are linked.

Pro-inflammatory substances such as cytokines are known to affect the cellular membrane metabolism, body water, and presumably the reactance and phase angle. These substances are released in acute respiratory distress syndrome (ARDS), let alone severe ARDS or SARS.

Alterations in the test may be due to hydration status, technical problems, or effect from physiologic events (e.g. menstruation, irregular eating, exercise, skin temperature, etc.). Try to do the test around the same time and same day of the week.

Fat mass

The adipose tissue (adipocyte) secretes resistin, which is an adipose tissue-specific factor inducing insulin resistance, linking diabetes mellitus to obesity.

Adiponectin is an anti-inflammatory, insulin-sensitizing adipocytokine. Adiposity is a form of chronic, low-grade inflammation. A number of studies have demonstrated that increases in inflammatory mediators like IL-6 and hs-CRP are associated with insulin resistance and metabolic syndrome.

Metabolic syndrome is strongly associated with the onset of endothelial dysfunction, which may explain why type 2 diabetes is a risk factor for atherosclerosis.

Body Cell Mass (BCM)

BCM is the metabolically active functioning tissue of the body. It is the protein-rich tissue. Loss of BCM (sarcopenia) is associated with a reduced quality of life, poor immune response, increased biological age, osteoporosis and impaired healing.

It takes three times longer to accumulate BCM than to deplete it. To increase BCM you must remove catabolic factors (stress, anxiety, sedentary behaviors, insulin resistance, etc.), increase protein calories and introduce resistance training.

Extra-Cellular Mass (ECM) includes fecal matter.

Total Body Bioimpedance Analysis (TBBIA) correlates well with other measures of fluid balance, hematocrit and serum protein level (McDonald J.J., 1993). In part two on this topic I will discuss ways to improve cell membrane health.

Jeffrey Tucker, DC, is the current president of the ACA Rehab Council. He practices in Los Angeles, Calif., and can be reached at drjeffreytucker.com.

 

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