Understanding Weight Gain and Loss
If the magazines on display at the supermarket checkout are any indication, we have an infatuation with weight. More accurately—and sadly—we have a real epidemic. Here are the sobering statistics:
- 2 of 3 Americans are overweight
- 1 in 3 US children are overweight or obese and are expected to develop diabetes by age 20
- 1 in 4 Americans between 17-24 years old are unfit for military duty due to obesity
- The current generation of children is the first in US history not expected to live longer than their parents
- $147 Billion/year is spent by Medicare, Medicaid, and private insurers on obesity related healthcare
- Obese people consume an estimated 40% more health care dollars compared to non-obese people
“Houston, we have a problem.” We’re fat and getting fatter. Consider the charts below, showing obesity rates in the US, by state, in 1985 compared to 2009.
U.S. Obesity Rates, 1985(Source: www.cdc.gov)
U.S. Obesity Rates, 2009(Source: www.cdc.gov)
You can see that, in just over 20 years, we went from 29 states having obesity rates so low that they couldn’t be measured, and no state with a rate greater 10-14%, to nine states with a rate greater than 30%, and only one state—Colorado—the lowest at 15-19%.
Why We Get Fat & Stay Fat
So what happened in 1985 that marked the beginning of this dramatic trend? In an effort to rein in heart disease, the American Medical Association, in concert with the US government, launched a campaign to reduce dietary fat. The reasoning went like this: Heart disease is caused by high cholesterol. High cholesterol is caused by dietary fat. Reduce fat intake and you will reduce heart disease. Some of you will recall the sudden explosion of low fat and fat-free foods appearing on store shelves in the mid to late ‘80’s.
But here’s the rub—what does food taste like when you remove the fat? Like cardboard! So to make food more palatable, food processors added sugar. And not just any sugar; they added high fructose corn syrup (HFCS). Why? Economics—it’s twice as sweet and half the price. We’ll discuss HFCS later on. As the charts clearly show, not only did reducing the fat not make us leaner, we actually got fatter faster! (Oh, and the cholesterol problem also got worse.)
In order to understand why we gain weight, and why it’s so hard to lose it, we need to understand how our bodies use and store food. There are 3 fuel sources that we can use for energy—carbohydrates (CHO), protein (PRO), and fat. We can store up to about 3 days worth of CHO, mainly in the liver and muscles, in the form of glycogen. Our fat storage capacity, however, is unlimited! Mind you, we don’t increase the number of fat cells. Except for a small increase during puberty, we have the same number of fat cells when we die as when we’re born. We simply stuff them bigger and bigger!
Once the glycogen storage tanks are full, excess CHO gets stored as fat. How does this happen? The key is the hormone insulin. Insulin is secreted by the pancreas gland in response to a CHO meal. Its main function is to reduce blood sugar and get the sugar into the cells where it can be used for energy or stored. However, insulin is also our main FAT storage hormone! Every excess sugar molecule gets combined with 3 free fatty acid molecules in the blood to form a triglyceride molecule (“tri” = three; “glyceride” = sugar). The triglycerides get stored in the fat cell. Insulin facilitates this process. The higher the insulin goes, the more fat gets stored.
Now think about what we are being told constantly about what constitutes a “healthy” diet: Whole grains, complex carbs, and low fat. ALL carbs become sugar, whether “good” or “bad” carbs, “high glycemic” or “low glycemic” carbs. Four grams of CHO equals 1 teaspoon of sugar. So that strawberry banana fat-free yogurt you enjoy every day has 35g carbohydrate—over 8 teaspoons of sugar! No wonder we gain weight or have trouble losing it. Fat doesn’t make us fat; SUGAR makes us fat and keeps us fat!
How to Lose the Weight
Carbohydrates are the easiest fuel for the body to use, and we will preferentially burn these before we burn any significant PRO or fat. As long as there is any stored CHO, fat burning will be limited. (Think of CHO as the “kindling” when starting a fire in your fireplace. Its burns quickly and easily; you don’t try to light the big logs—the “fat”—first.) Therefore, to force the body to burn meaningful amounts of fat, we need to burn almost all of the stored CHO, and then stop eating CHO until we’ve achieved our weight loss goal. Burning stored fat will continue as long as there is no CHO to burn.
Think of it this way. All of your stored excess fat is your body’s built-in grocery store! This is what you will “feed” off of. But it only happens if you first burn down the CHO and force the fat burning. The problem is, once you eliminate the CHO, you will burn BOTH fat and protein—the body will not discriminate. This process is called gluconeogenesis (gluco = sugar, neo = new, genesis = creation). The protein and fat get converted to sugars that the body can use for fuel.
But you don’t want to burn PRO. Protein is muscle, and burning it will result in a net loss of lean muscle mass. Muscle burns more calories at rest than other tissue, and muscle is essential to help keep the weight off. Loss of lean muscle mass is a problem not only with many “low carb” diets but with any diet that restricts calories and yet keeps the same relative proportions of CHO, PRO, and fat. Weight Watchers®, for example, admitted in a 2009 Boston Globe article that up to 30% of the weight lost on its program was lean muscle mass.
To prevent loss of muscle protein, you need to replace the protein that’s burned. An average person needs ½ gram of protein per pound of lean body weight per day. That’s roughly 70g a day for a 180-pound man, and 50g for a 150-pound woman. Exercise increases protein and fat burning, so physically active people need additional protein. Protein is best taken at each meal, rather than all at once.
Keep in mind that this amount of protein is NOT high protein. It will not hurt your kidneys. It is the bare minimum to prevent a net loss of muscle. The key is to choose high quality protein that’s low in saturated fat and carbohydrate. Egg whites, chicken breast, fish & seafood, lean pork and lean cuts of beef are all acceptable. Tofu is also OK, but whole soy has a high estrogenic potential. Low fat cottage cheese and plain Greek yogurt can also be used sparingly (they tend to be higher in CHO content). There are also high quality protein shakes available, but watch the fat and carbohydrate contents carefully.
A Typical Daily Meal Plan
So what does this look like in practice? The following is a sample of a typical daily meal plan for weight loss.
Breakfast
1 whole egg + 3-4 egg whites, scrambled
Sea salt and spices to taste
2 8oz glasses of water
Optional: coffee, 1oz skim milk if desired, Stevia for sweetener.
Lunch
1 grilled chicken breast
2 cups (2 handfuls) of mixed field greens, fresh spinach, or vegetables
1 tablespoon olive oil + apple cider vinegar dressing, plus spices to taste
2 8oz glasses of water
Dinner
5-8oz fish, seafood, chicken, lean pork or beef
2 cups vegetables
Unlimited salad (but only 1 tablespoon olive oil + apple cider vinegar
Sea salt and spices to taste
2 8oz glasses of water
Snack
½ cup low fat cottage cheese or 1 serving of plain Greek yogurt
There are several factors to note. First, you must have 15-20g PRO at each meal and snack. This is to replace the PRO that is getting burned. Second, you must eat regularly. (This includes a small PRO snack 30-60 minutes before bed to prevent PRO loss during sleep.) This sounds counterintuitive, but you need to eat to lose! When you skip a meal your body’s enzyme systems go into “preservation mode,” and the next meal you eat will get stored rather than burned. Third, vegetables and water are essential, not optional.
Note also that there is no bread, cereal, pasta, dairy, butter, butter substitutes, fruit or fruit juices, nuts, alcohol, or junk food. All breads, cereal, pasta, and fruit are sugars. Nuts contain too much saturated fat—the very thing you are trying to burn off. And alcohol interferes with the gluconeogenesis in the liver, slowing down your weight loss.
Don’t fret! Once you’ve lost the weight you will go back to eating the things you enjoy, including fruit and alcohol. But you have a goal, and there are sacrifices that need to be made to reach that goal.
The first 3-4 days are the hardest, as you go through CHO withdrawal and clear out the built-up toxins. But stick with it, and on day 4-5 the fat burning kicks in and there is a surge of energy and an increased sense of well-being.
Controlling Insulin is the Key
As noted above, insulin is the underlying factor in gaining weight and keeping it off. In our typical high CHO diet, the pancreas continues to secrete insulin. Every high CHO meal or snack causes an insulin spike. Over time, the cells that respond to insulin become “numb” or resistant to the insulin. This forces the pancreas to secrete even higher amounts of insulin to “wake up” the resistant cells.
Remember that insulin also stimulates fat storage. So the higher the insulin goes, the more fat gets stored. This is precisely how Type 2 diabetes develops. This is also the mechanism underlying the modern-day medical epidemic, “Metabolic Syndrome,” also known as Syndrome X. Characterized by high blood pressure, obesity, diabetes, and high cholesterol, insulin resistance is the unifying cause.
In order to heal the body, to lose the weight and keep it off, you need to heal the insulin resistance. This can only be done by resting the pancreas, by reducing insulin production to the absolute lowest level possible. And this is done by reducing CHO intake to the lowest levels possible.
The amazing part of all this is that, not only will you lose the weight, but you will also dramatically reduce, if not outright get rid of, the high blood pressure, Type 2 diabetes, and high cholesterol. I know—we’ve seen it happen regularly, patients getting completely off of their medications!
Other conditions are also related to insulin resistance. Polycystic Ovary Syndrome, gout, arthritis, and even cancer all can be linked to high insulin levels and insulin resistance.
My point is this—many diets will help you lose weight. But very few will actually heal the body, address the root causes of weight gain and disease, and help keep the weight off.
Once You’ve Lost The Weight
By following the principles outlined above strictly, you can realistically expect to lose up to 3 lbs a week for women and 4-7 lbs a week for men.
Once you’ve reached your weight loss goal, it is imperative to transition gradually to the next phase. Keep in mind that up to now your pancreas has been relatively quiet, secreting minimal insulin. This is where most diets fail. If you suddenly go back to eating a so-called “healthy diet,” one high in complex carbs, you’ll simply start spiking the insulin all over again, followed by the weight gain. Up to 95% of people who lose weight put it back on again.
How do you prevent this? You reintroduce CHO slowly and gradually, so your system can adapt. For 14 days introduce CHO only at breakfast. Here’s where you can again enjoy a piece of fruit (no fruit juice!), some fruit yogurt or a glass of milk, or whole grain toast, along with your protein. But avoid CHO the rest of the day. This way the pancreas secretes just a little insulin, you burn off the CHO the rest of the day, and the insulin levels gradually drop back down.
After 14 days you’re ready to embark on truly healthy eating for the rest of your life. How do you keep the weight off? It’s remarkably simple.
For breakfast (and, yes, you must eat breakfast!), eat a balanced meal of CHO, PRO, and fat.
For lunch and dinner, remember that insulin both metabolizes CHO and stores fat. So the key is keeping meals high in CHO separate from meals high in fat. High CHO raises insulin; if there is minimal fat around, none gets stored. Conversely, a meal high in fat but low in CHO raises insulin minimally, so again no significant amount of fat gets stored.
What do such meals look like? Pasta with grilled chicken has CHO and protein, but minimal fat. Stay away from the mac & cheese or fettuccine alfredo (high CHO and high fat). Get the picture? Do this 5 days a week.
One day a week is a “fun day.” Eat whatever you want, no restrictions. But the next day severely restrict the CHO and fat again. This allows the high insulin to come back down so you don’t store all the CHO and fat you ate the day before.
A Few Final Words.
First, no diet is a vaccine against obesity. Don’t blame a diet if you fail to abide by it.
Second, athletes need extra protein, as much as 1-2 grams per pound of lean body weight. Increased exercise increases demand for fuel, and you don’t want to burn muscle. Also, once on the “maintenance phase,” athletes should replace CHO and PRO stores within 30-60 minutes after exercise.
Lastly, go through your cupboards and get rid of anything that contains high fructose corn syrup, corn syrup, or corn sugar, and avoid buying anything that contains it or its derivatives. Fructose is a toxin, and the body has no receptors to metabolize it. This is also why you should avoid fruit juice—it concentrates the fructose, and you do not have the benefit of the fiber. Eat only whole fruit. (Sorry, pulp doesn’t count!)
As Hippocrates said, “Let food be your medicine, and medicine be your food.” It’s both the most potent “drug” and the most potent “toxin.”
Submitted by Paul D. Tortland, DO of Valley Sports Physicians and Orthopedic Medicine in Avon, CT. For more information, call 860-675-0357 or visit www.jockdoctors.com. See ad on page .