- What Is Known about Obesity
- Healthy Steps: Obesity—First Steps
- Healthy Steps: Obesity—Full Program
- Obesity Prevention
- From Dr. Deborah's Desk
Have you noticed a slowly increasing waist size? The first sign may be that last year's bathing suit doesn't fit, but the steps to follow are much worse. For both men and women, even loose shirts are stretched taut over pregnancy-shaped abdomens, and many folks find they don't fit comfortably in airplane seats. Your doctor may be the last person to tell you that you have a weight problem - often because your doctor has a weight problem as well. The nation as a whole, and the medical profession included, are suffering a serious obesity epidemic.
For years, Americans have been urged to eat less meat, avoid butter and cholesterol, use fat sparingly, and drink fat-free milk while stocking up on carbohydrates for energy. The result? As a nation, we've gotten fatter, sicker and more dependent on pharmaceutical drugs. Even coffin makers have had to adjust the width of caskets to accommodate wider bodies. The future doesn't look too rosy, either. Experts predict that by the year 2020, the vast majority of the population will be overweight or obese, and more than half will be diabetic or pre-diabetic.
Along with obesity comes a host of unpleasant health and economic repercussions. At the turn of the 20th century, arteriosclerosis was practically unheard of, but cardiovascular disease now ranks as the leading cause of death in the US. Following closely behind are cancer, diabetes, and respiratory illnesses. In short, as a society, we are fat and sick. On top of this, the pervasive emphasis on dieting and the long list of forbidden foods has taken the pleasure out of eating. If you stray and dare to indulge, you're plagued by regret and vow to be “good” from now on. Herein lies the problem-we've lost perspective on what “good” means when it comes to food.
Most Americans obtain the bulk of their calories from carbohydrates in the form of grains, fructose, and sugar. All carbohydrates cause the pancreas to release the insulin hormone, which is the body's elegant way of managing blood glucose (a.k.a. blood sugar). Blood glucose must be maintained within fairly narrow parameters. Too little glucose causes energy levels to plummet, but too much harms organs and tissues. Eat too many carbohydrates, and your pancreas will pump out extra insulin to mop up the excess blood sugar. Insulin instructs fat tissues to turn excess sugar into fat and store it. Ironically, obesity is your body's initial attempt to protect you from diabetes.
Eventually, however, if the body is continually deluged with high levels of blood glucose and insulin, this protective system is exhausted. Cells become resistant to insulin, excess sugar remains in the bloodstream, and diabetes is the inevitable destination. High insulin levels not only make your body hang onto fat, they also accelerate the ageing process and are associated with many common cancers.
It's clear that the commonly accepted low-fat, high-carbohydrate diet just doesn't work for permanent weight loss. If you struggle with trying to lose weight, it's important to understand that a low-fat, high-carb diet destabilizes blood sugar and consequently keeps you hungry. The best dietary approach to normalizing weight while reducing the risk of degenerative disease is the opposite of a low-fat, high-carb diet. Protein and fats do not raise blood sugar levels, nor do they spike insulin in the same way as do carbohydrates. Switch to a diet that is low in carbohydrates and high in healthful fats, and you'll find your weight will normalize, your blood sugar and cholesterol profiles will improve, and you can once again enjoy delicious and satisfying meals.
Our ancestors thrived on organ meats, whole-cream raw milk, butter, plenty of saturated animal fat, and high-cholesterol foods-all foods that make modern nutritionists gasp in horror. In ages past, including just a century ago, the serious threats to health were childbirth, accidents and infectious disease, but if you survived those, evidence suggests that people lived relatively long and healthy lives. Now that we have modern medical solutions to earlier problems, we are faced with the onset of chronic disease at ages younger than we have ever seen before, and they are largely induced by our high carbohydrate (sugar) diet.
Along with a radical change in our eating habits, we have also had to deal with a huge influx of toxic chemicals. These chemicals are endemic in our water, atmosphere, and food supply. Most of these toxins are fat-soluble. One of the ways the body combats toxins is to encapsulate them in fat. This survival mechanism protects us from the harmful effects of toxins. When we lose weight, toxins stored in fat are released into the bloodstream, which often causes fatigue and feelings of ill health. The release of toxins can trigger in some the urge to overeat because eating more than you need sends the toxins back into fat storage. This is why weight loss must be accompanied by some form of detoxification to be successful.
Fat used to be thought of as merely a storage area for excess calories. We now know fat is actually a metabolic organ in its own right and not just a passive storage site, which is currently attracting a lot of metabolic interest. White adipose fat cells produce the powerful hormone leptin. Two of leptin's many functions are to tell your brain when you are full and to relay information about the amount of energy on hand. Following a meal, your brain should register satiety and stop you from wanting to overeat. Your metabolic rate should then adjust according to the amount of energy the brain perceives as stored. When your body is flooded with leptin, however, these messages can get scrambled, much like what happens in insulin resistance. In the confusion, two things happen. First, the satiety response is switched off, making you constantly hungry, even if you have just eaten. Secondly, your body starts preparing for a famine by slowing down metabolism and shutting off fat-burning, despite the fact that there is sufficient or excess energy stored. The net result is more fat and consequently increased leptin production.
The more fat you have, the more leptin is released into your bloodstream. At this point, dieting and exercise will take huge amounts of willpower and ultimately get you nowhere. You must reverse both insulin and leptin resistance to conquer obesity and achieve and maintain a healthy weight. Because the recommendation for lowering both hormones is the same (restrict carbohydrates) it is not known for sure whether leptin exerts an independent influence.
For the greatest weight improvement with the fewest steps, do the following:
- Avoid sugars and starches and restrict all carbohydrates. They promote fat storage and inhibit fat burning.
- Increase protein, salad greens, and vegetables. Allow yourself to eat fat.
- Stop eating when you are full.
A comprehensive weight loss program involves many areas in which action steps can be taken, gradually or all at once. Start by following basic nutrition and healthy lifestyle guidelines, with the following modifications: (Weight loss is much simpler if some sort of meat is eaten. Vegetarians may rely on dairy products and eggs, and I'll have a separate article for your interests later. A vegan diet is not a healthy diet, nor can it be modified for weight loss.)
Cook using any moderate heat source. No breading is permitted. Stop eating when you are full. When hungry, eat your choice of the following:
- Meat. This includes beef, pork, ham, bacon, lamb, and veal. For processed meats, check the label; the carb count should be about 1 gram per serving. Grass-fed provides countless benefits over grain-finished meat and is well worth the extra expense if you can afford it. Please enjoy the fat on the meat, too; it aids in digestion, neurological function and nutrient absorption.
- Poultry. Enjoy chicken, turkey, duck, and other fowl, with the skin.
- Fish and shellfish. Choose wild-caught salmon and other Monterey Bay Aquarium-approved seafood.
- Eggs. Eat as many whole eggs from pasture-raised hens as you like. Yolks may be raw, whites only cooked.
Foods You Must Eat Every Day
- Greens. Consume 2 cups daily (measured raw) of any leafy vegetable, raw or cooked.
- Vegetables. Eat 1 cup (measured uncooked) of artichokes, asparagus, broccoli, Brussels sprouts, cauliflower, celery, cucumber, eggplant, green beans, jicama, leeks, mushrooms, okra, onions, peppers, pumpkins, shallots, snow peas, sprouts (bean and others), sugar snap peas, summer squash, tomatoes, rhubarb, wax beans, or zucchini.
- (Bone) Broth Soup. Enjoy 2 cups daily to replace minerals (unless you are on a sodium-restricted diet).
You may consume additional amounts of the above foods ONLY if you are still hungry after first eating meat, poultry, fish, seafood, or eggs.
Foods Allowed in Limited Quantities
- Organic cheese. Consume up to 4 ounces of cheese, preferably raw, per day (less than 1 gram of carbohydrates per serving). Avoid processed cheese.
- Organic cream. Enjoy up to 4 tablespoons heavy, light, or sour cream (no half-and-half) daily.
- Mayonnaise: Use up to 4 tablespoons per day.
- Olives. Enjoy up to 6 black or green olives per day.
- Avocado. Eat up to half an avocado per day.
- Lemon/lime juice. Consume up to 4 teaspoons per day.
- Tamari. Use up to 4 tablespoons per day.
- Pickles. Enjoy up to 2 servings per day of dill (no sugar) pickles.
- Snacks. You can consume limited portions of sausage, pepperoni, other meats, and deviled eggs.
Foods to Avoid
Your primary food restriction is carbohydrate-related.
- All sugars. This includes simple carbs and starches (complex carbs). Sugar, honey, maple syrup, molasses, corn syrup, beer, milk, flavored yogurts, fruit, and fruit juices are prohibited. The only carbs to eat are the nutritionally dense, fiber-rich vegetables listed above.
- Starches. This category comprises grains, rice, cereals, flour, cornstarch, breads, pasta, bagels, starchy vegetables such as slow-cooked beans, (pinto, lima, black beans), root vegetables, peas, and all potato products.
Fats and Oils
Fats in general are important to include. Do not follow a low-fat diet!
- Healthful fats. All healthful fats and oils are allowed, including organic butter. Avoid margarine and hydrogenated oils.
- Salad dressings. The ideal is oil and vinegar or lemon juice. Prepared dressings must be a maximum of 1-2 grams of carbs per serving. Avoid “light/lite” dressings.
- Frying. Use fats that are solid at room temperatures (e.g., ghee, coconut, and lard).
Sweeteners and Desserts
- Stevia. Both stevia and erythritol (xylitol) are acceptable sweeteners.
- Avoid non-caloric sweeteners: they have not been shown to aid fat loss.
- Water. Drink as much filtered water, zero-carb seltzers, and herbal tea as you like.
- Coffee/tea. Enjoy up to 3 cups a day of caffeinated coffee or tea.
- Alcohol. Avoid alcohol initially. As weight loss and new dietary patterns are established, low-carbohydrate alcohol (not beer) is permitted in moderate quantities.
Important Tips and Reminders
- Eat when you are hungry and stop when you are full. You are not counting calories. I recommend you start your day with a nutritious meal.
- The following are NOT on the diet: sugar, bread, cereal, flour, fruits, juices, honey, milk, yogurt, nuts, nut butters, canned soups, dairy substitutes, ketchup, sweet condiments, and relishes.
- Beware of fat-free or “lite” diet products and foods containing hidden sugars such as coleslaw or “sugar-free” cookies. Check the labels of all foods. Avoid products labeled as “great for low-carb diets.”
Weight Loss Support and Problem Solving
Low-carb adaptation occurs between starting a low-carb diet and feeling great on a low-carb diet. You can smooth the transition by doing the following:
- Do not skimp on fat. Fat aids with digestion, nutrient absorption, and brain function.
- Consume unlimited quantities of probiotics and carefully add digestive enzymes. These can help your digestive system as you switch to low-carb eating. Integrative Therapeutics Probiotic Pearls are handy, non-refrigerated, and gentle. Start with 2 a day, increase to 4-6 daily as you like. After taking one form of probiotic for a while, consider rotating among different products: they all provide a different variety and quantity, and experimentation often helps you find the one that works the best with your digestive system. Add Thorne Research DiPan-9, taking 1-2 capsules with each meal can be helpful if your digestion feels challenged by this eating plan.
- Metabolic Maintenance L-Glutamine 500 mg. L-Glutamine provides good brain food if you feel foggy on a low-carbohydrate diet. Take 500-10,000 mg in pill or powder (more quickly absorbed) form a day. Besides feeding the brain, L-glutamine will help keep your intestines healthy during the process of adaptation to a different diet.
- Exercise. An exercise program helps you bypass insulin resistance, rewire fuel distribution to increase muscle rather than fat, and achieve general well-being. If you are hungry after exercise, forget “calories in, calories out, buck up.” You MUST eat by the same standards as at other times: Eat when you are hungry, start with proteins, add greens or vegetables and fats, and stop when you are full. Do not think you can burn up calories by exercising and go off the eating plan.
Homeopathic treatment of excess weight requires consultation with a skilled professional homeopath. A homeopathic remedy will not change the dietary rules required, but can aid in personal resolve.
Contrary to media stereotypes, being overweight does not mean you are lazy, weak-willed, or greedy. It means your system is in crisis and is fighting for survival. Our bodies are designed to function in an exquisitely intricate dance of hormonal communication. Eating large amounts of carbohydrates in the form of sugar (especially fructose) and grains disrupts this dance and programs you to get and stay fat. If diet is largely responsible for getting us into this mess, it makes sense that diet can get us out of it-and in a way pills and potions cannot.
Hippocrates said it best when he urged, “Let food be thy medicine and medicine be thy food.” By food, we mean real food, not the chemical-laden, irradiated, refined, homogenized, processed, denatured rubbish that passes for nourishment in most supermarkets nowadays. Real food tastes good. It is more satisfying than junk food, fills you up without weighing you down, and allows your body to do what it does best-generate real health and energy.
A healthy diet comprising the proper assortment of fresh, unprocessed, nutrient-dense foods influences health and weight in a healthy and sustainable way. Many people experience an added benefit from an exercise program, and there is some scientific validation that exercise increases insulin sensitivity and reduces stress.
Anything that disturbs hormone sequencing is going to negatively impact health and could cause you to gain weight. For example, stress and sleep deprivation have both been linked to increased fat storage. High stress levels, with or without increased cortisol levels, can cause you to eat more, and with weight gain comes more stress, both physiological and psychological. When you don't get enough sleep, the hormone responsible for controlling appetite is suppressed, and the hormone controlling hunger is activated. Remember that foods with fats are nature's natural appetite suppressant, but they take about twenty minutes to act. Listening to your body; nurturing it by feeding it well; and caring for your emotional, physical, and spiritual needs are all important keys to achieving and maintaining your optimal weight.
I will be forever indebted to the brilliant contributions made by Gary Taubes in his two ground-breaking books, Good Calories, Bad Calories and Why We Get Fat. I had decades of relative failure at counseling people on reining in their ill-behaved appetites before reading his books and really grasping the difference between his message and conventional dietary advice. It goes against decades of conventional wisdom (so-called) to learn that grabbing an apple does not send a good metabolic message to your body.
Today I would be hard-pressed to choose what is the most exciting success story from my practice. Perhaps Jeanie who came in one day and said “Twenty five down and the 16's are gone forever.” She'd lost 25 pounds and knew that they would stay off, so her size 16's could go to Goodwill. What fantastic confidence to know that yo-yo dieting is gone. Just that change alone will make her life a healthier one.
Or Tania, who sends me a regular monthly email cataloging both pounds and inches lost. Or Mike, whose weight dropped nicely but who was most happy about the improvement in his once-diabetic lab tests. Or friends of patients, who stop by and politely ask if they could have a copy of the diet …
If you have an insatiable appetite for knowledge I highly recommend you read Gary Taubes' tome, "Good Calories, Bad Calories". If you are more of a “cut-to-the-chase” reader, go for "Why We Get Fat: And What to Do About It". You will never look at food the same way again.