A few weeks back, I wrote about my friend Jerry’s (name changed) ongoing battle with heart disease, obesity, and type 2 diabetes. See part 1 here. He’s been out of the hospital for about six weeks.
I spoke to him today, and he says he’s lost about 30 pounds, his blood glucose is under control, and he feels great.
While Jerry is not currently dieting, he has started to adopt a new way of eating. He’s laying off the refined carbs as much as possible. He knows that indulging in bread, pasta, and potatoes aren’t going to help his cause.
Jerry told me that when he was younger, he tried the Atkins Diet, and he lost a lot of weight so he knows cutting carbs work for weight loss. Now if I could only convince him of the evils of diet soda, he’d really be doing well.
I’m still trying to encourage him to lose at least 30 pounds more. He says he knows he should, and he’ll keep trying. If Jerry wants to lose those extra 30 pounds, he might have to be a bit more aggressive in his approach.
Before we can discuss what Jerry should do, let’s see how Jerry got into this predicament in the first place.
Why Do People Become Obese?
Most people unwittingly confuse obesity with gluttony. While this may be the case in some circumstances, I don’t feel this is true for the majority of obese people.
Obesity and type 2 diabetes are a relatively new phenomenon in our country. Here’s a chart of the rise in obesity rates since the 1960s.
You can see that the explosion of obesity rates occurred around 1980. Was there something that happened in 1980 that caused this?
In 1980, the USDA came out with their new dietary guidelines on healthy eating for the U.S. public. The USDA, relying on the flawed research of Dr. Ancel Keyes, recommended a diet high in carbohydrates and low in fats (HCLF).
The idea behind the HCLF diet was that Keyes’ research proved that an increased consumption of saturated fat caused heart disease. In order to lower this risk, it was suggested that people consume a diet lower in saturated fat and higher in carbohydrates.
Even though Keyes’ research has since been shown to be seriously in error, the U.S. Department of Agriculture (USDA) still relies on his data for its diet recommendations.
They advise that Americans consume 51% of their daily calories as carbohydrate, 32% as fat, and 18% as protein (I know the numbers don’t add to 100%, but I took the numbers from the USDA site). It’s also recommended that saturated fats total less than 10% of total calories.
The FDA recommends a similar breakdown of 60% calories from carbs, 30% from fat, and 10% from protein.
The Wrong Assumption Of A High-Carbohydrate Diet
Besides the fact that Ancel Keyes, the USDA, and the American Heart Association are wrong about saturated fats, they failed to anticipate what a high carbohydrate-diet would do to the average American.
Most mainstream diet researchers adhere to the Calorie In – Calorie Out Theory of weight gain.
In other words, they assume that when it comes to weight loss or gain, your body will treat a calorie of carbohydrate the same as a calorie of fat.
This belief is false, and it’s led to the recommendation of a diet that has had devastating effects on the health of the American public.
The Body Does Not Treat All Calories The Same
Researchers such as Dr. Jason Fung, Gary Taubes, Dr. David Ludwig, and Dr. Robert Lustig have proposed a new theory that suggests your body exhibits a completely different response to carbohydrates than to fat or protein. This is commonly known as the Carbohydrate-Insulin theory of obesity.
In this model, obesity is primarily a result of the overconsumption of refined carbohydrates such as sugar, pasta, bread, rice, and fructose. (And to a lesser extent carb dense vegetables like potatoes.)
Subsequently, the over-consumption of refined carbs over time leads to a state of hyperinsulinemia which causes the body to respond in a series of potentially harmful ways.
The Beauty Of Balanced Food Consumption
When you consume a refined carb, your small intestine breaks it down into glucose. This glucose eventually finds its way to your bloodstream. Your pancreas in response secretes insulin to remove the glucose from your blood.
Insulin is basically a storage hormone. Whatever glucose you don’t use for energy will be converted into glycogen in the liver and stored for future energy.
When you sleep, insulin levels fall, and your body releases some of the stored food energy to power your body. If your times of eating and fasting are balanced, everything is okay.
Unbalancing The System
However, your liver has a limited storage capacity for glycogen. If you consume more carbs (glucose) than your liver can store as glycogen, then your liver converts the excess glucose to fat. Insulin will then store this fat in fat cells (adipocytes) throughout your body.
So you get fatter (though you may not be obese). If you continue to overconsume refined carbs year after year, you will get fatter and fatter.
Nobody becomes obese overnight. But if you gained just 2 pounds a year for 30 years, you’ll end up 60 pounds overweight.
The Big Problem: Too Much Insulin
When an overconsumption of refined carbs continues for years, some people (but not all) may find at a certain point that their cells have become resistant to the work of insulin. In response, their body produces more insulin to try and get the fat into fat cells. But no luck. They’re all filled up.
However, the fat has to go somewhere. So insulin tries to pack it in their liver (fatty liver), pancreas, muscles, around their abdomen, wherever it can.
But these organs also become resistant to insulin. Eventually, the pancreas cannot keep up with insulin demand. Glucose starts piling up in their blood. Now they have developed type 2 diabetes.
This is a simplified version of the theory, but I think you get the picture.
See Dr. Peter Attia explain why we should be focusing on excess insulin as the cause of obesity and diabetes.
Obesity Is Not A Problem Of Overeating
As you can discern from the Carbohydrate-Insulin model, obesity is a hormonal problem. Remember Jerry is taking insulin. Why? Because his body’s own insulin is not working properly. It’s not that he doesn’t have enough insulin.
He has too much insulin.
A type 1 diabetic doesn’t have enough of their own insulin. So they need insulin.
However, a type 2 diabetic has enough insulin. The problem is that their cells have become resistant to the effect of the insulin they have.
Unfortunately, doctors give patients insulin hoping that more insulin will solve the problem.
Well, it does solve the problem of high blood glucose, but it doesn’t solve the problem of why blood glucose is high in the first place. More insulin treats a symptom and not the cause.
The problem is insulin resistance that is caused by too much insulin.
It’s estimated that approximately 115 million Americans have diabetes or prediabetes. Most of these people probably also have insulin resistance.
The Problem Of Obesity And Hunger
Along with the problem of hyperinsulinemia, Jerry might have another hurdle to clear.
Researchers are beginning to find that hunger cravings have a big role to play in obesity. There are several theories on this, but I’ll mention just two.
The first is a dysregulation of the hormone leptin. When fat cells are full, they secrete leptin. Leptin then signals your brain that you have enough stored energy. Your brain then produces a feeling of satiety and you stop eating.
However, when there is an overabundance of fat cells or they grow too large, more leptin is secreted. Eventually, a resistance to the effects of leptin develops. That means that even though you’ve eaten enough, your brain is telling you that you’re still hungry. Consequently, you eat more. See here.
There is also research being done concerning the relationship between dopamine response in the brain and food cravings. It appears that dopamine is related to a reward response, and this could induce people to overconsume. There is still some controversy in this field.
As you can see, obesity is a lot more complicated than just suggesting someone is a glutton.
Eating Less Calories Is Not The Answer
Simply telling Jerry to eat fewer calories won’t work over the long haul. If he cuts his caloric intake down to 1500 calories but that diet primarily consists of bread, pasta, potatoes, and diet soda instead of healthy fat, moderate protein, and low-carb leafy green vegetables he may have a hard time losing any kind of significant weight.
Also, as we saw last time, the problem of body set weight works against ordinary calorie restricted dieting. Yes, if Jerry cuts calories he may lose weight initially. However, eventually, the weight will return.
What is Jerry to do? Is he consigned to spend the rest of his life obese and dependent on insulin? Not necessarily.
He’s already made an important step by choosing a new way of eating. However, there are some other key steps he can take if he wants to lose that extra 30 pounds.
Healing Obesity And Diabetes
Reducing the amount of excess insulin in the body is the one sure way to cure obesity and type 2 diabetes.
This is done through a number of ways.
The first is a new way of eating. This entails the reduced consumption of refined carbohydrates, sugar, and high-fructose corn syrup. Significantly lowering carbohydrate and sugar intake will lower your blood glucose. That will subsequently lower the secretion of insulin.
However, for the very obese, losing weight this way may take a considerable amount of time.
Very Low-Carbohydrate Diets
Many people are finding that they can successfully achieve their weight loss goals by choosing to adopt a very low-carbohydrate healthy-fat diet (VLCHF). This diet typically consists of less than 50 grams of carbohydrate, moderate protein, and a high amount of healthy fat.
Some dieters have achieved even quicker weight loss by going on an extremely low carb diet. This diet consists of less than 30 grams of carbohydrate per day. This is commonly called a ketogenic diet because your body in the absence of glucose will turn to ketones as a source of fuel.
An important caution here is that if you want to go on one of these diets and you’re a diabetic or are on an insulin reducing medication, you should be monitored by your doctor. Since a low-carb diet reduces blood glucose, the addition of an insulin lowering medication might lower your blood glucose to unsafe levels.
Fasting Also Reduces Insulin
Again, the goal of defeating obesity is to lower the amount of insulin the body is producing in response to glucose.
A time-honored way of doing this is through fasting. Fasting can be done in a variety of ways.
A good way to become adapted to fasting is to practice time-restricted eating. This means you compress your food consumption into an 8-hour window or less.
For example, if you eat your last meal at 6 P.M., you wouldn’t eat again until 12 P.M. the following day.
This has the effect of lowering your insulin production because, obviously, you’re not eating for extended periods. Also, remember that when you’re fasting (as when you’re sleeping), your body will mobilize stored body fat from fat cells and burn it for energy instead of glucose.
Barbara and I have been practicing time-restricted eating for about 6 months. It’s generally easier to start fasting when you’ve already been low carb for some time.
For an excellent overview of time-restricted eating, see here.
Intermittent And Extended Fasting
It stands to reason that if time-restricted eating will lower your insulin response, then not eating for even longer periods (fasting) will help even more.
This type of fasting generally includes longer periods of non-eating than does time-restricted eating. For example the 5:2 diet includes two days of non-eating in a 7 day period.
Fasting shouldn’t be confused with calorie restriction. Its effects on the body in lowering insulin and insulin resistance are completely different. Fasting results in less hunger, more visceral fat loss, more lean muscle gain, better insulin control, and less metabolic slowdown than simple caloric restriction. See here.
Cautions Against Fasting
While fasting is an excellent means for insulin regulation and weight loss, the following individuals should avoid fasting:
- Underweight individuals (defined as having a body mass index (BMI) of 18.5 or less)
- Malnourished individuals
- Children should not fast for longer than 24 hours
- Pregnant and/or breastfeeding women
I generally don’t fast for longer than 24 hours. Fasting is a stressful activity and can raise cortisol levels. Since I’m still recovering from chronic fatigue syndrome, raising my cortisol unnecessarily is not something I want to do.
Barbara, however, often engages in 36-hour fasts which have really helped her in her weight loss program.
So there we have it. If Jerry wants to heal his type 2 diabetes and obesity, the best strategies are a LCHF way of eating and to engage in some form of fasting.
He’s already watching his carbs. I pray he starts fasting in some manner so he can lose those extra 30 pounds.
That’s it for this week. I’d love to hear your thoughts.