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EventsModern Prejudice
November 23 2011 by Dr. Andreas Eenfeldt, MD
in Weight loss
in Weight loss 
Prejudice is usually more common in uneducated people. When it comes to obesity treatment the opposite is true.
Like professor Lustig says, this outdated idea (“eat less, run more”) is holding us back. It’s stopping people with obesity from getting better advice, based on modern science. Not only that, it breeds nasty prejudice against all people with weight problems.
What is your response to these recent articles?
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2990627/
http://www.ncbi.nlm.nih.gov/pubmed/21621573
http://www.nature.com/oby/journal/v18/n2/full/oby2009228a.html
It seems that these suggest that "it's insulin" doesn't cut it for obesity.
It's true to say that they're not obese because they're gluttons and sloths, but there's evidence that resistance training may reduce insulin resistance (and thus leptin), telling people exercise does nothing is something that Taubes seems to suggest, which is true to a point, but again, there is simply too much anecdotal evidence showing that people who lose weight balloon right back up due to homeostatic factors.
Not to mention the success of low fat/high carb diets in the real world. Ever heard of the 80/10/10 diet? Doubt they "reduced carb intake" - if anything it was increased.
Why don't you give it a try and see if it works first?
The 80/10/10 diet might work if you do exercise a lot (to deplete your glucogen a prevent insulin spikes), but I doubt it will work on everyone. On the other hand, the diet has the advantage that many products are raw and contain fibre, which limits the amount and the speed of carbohydrate absorption, which is maybe why it is not so bad. The heart, among other parts of the body, require fat for proper functioning; luckily, the liver turns all those excess carbohydrates into the saturated fats we need; otherwise, all anti-fat crazes would be dead by now.
I never challenged the validity of the high fat/low carb diet for weight loss, and I'm glad you're losing weight.
I doubt the 80/10/10 will work for everyone as well, I'm simply citing that high carb diets work as well despite Taubes' claims that the reason all diets work is by reduction in carbohydrates, which is a strawman at best.
Thank you very much for responding me about my rice question.
Now im trying to understand from where will come the necessary carbo in a LCHF diet. For sports pratice, for example. Woud you help me?
And about the gray zone, I'm begining to study about the Brazilian indian diet. Along with protein and fats, originally they had a lot of fruits and cassava, and they were not obese, diabetics, hypertensive...It's interessing to take a look.
Many thanks again, Lúcio.
@Jordan, "...success of low fat/high carb diets in the real world." Really? If it were that simple, we wouldn't have the problem with obesity that we now have. Temporary success, perhaps, for some, if they restrict calories as well. But in time, the lack of fat is going to induce hunger, falling off the wagon and regain of weight and then some. They are, indeed, likely to balloon up again. Many, if not most, who lose weight be restricting carbohydrates--instead of calories or fat--manage not to balloon right back up again--at least not to their former selves. That points to insulin. And if it's not insulin, why do people who can't produce insulin and therefore have little or none in the system (type 1 diabetics) lose weight until they are diagnosed and start taking insulin? If there is (in a sense) a set point that controls amount of fat and, indirectly, weight, that set point probably has to do with how much insulin is floating around. Basically, if you have excess insulin floating around all the time, your set point will rise and you will gain fat until you reach a point where your fat cells can release fatty acids despite the excess insulin (which inhibits lypolysis). At that point weight stabilizes. To lose weight (lower set point?) one needs to restrict carbs, thus lowering the amount of insulin floating around, allowing fat cells to release fatty acids even as weight decreases. So, regardless of how you look at it, it's still about insulin. If insulin is the fat storing hormone, and I don't think believe that is in question, then it only makes sense that it is, indeed about insulin. Of course, fat cells can become resistant to insulin at any point along this road, and then all bets are off and you are in much worse trouble regardless of how little or much actual weight you have gained.
The same could be said of low carb diets. Low carbers binging on bread, pasta, rice, bagels, etc. aren't exactly unheard of- in fact members of several boards balloon up passed their original weight after binging.
The Type 1 diabetics also inject amylin in their bodies with the insulin, which is antilypotic, suggesting the side effect of weight gain is pretty much limited to diabetics.
As for insulin controlling the setpoint, the fact of the matter is it is the other way around, the brain controls insulin levels.
As a long time reader, I remember reading Dietdoctors comment, that vegan lchf can be healthy. Could I get more ideas how to build lchf menu with more plant foods because I do want to live a long and healthy life but meat, dairy and eggs are not something I enjoy and can imagine eating every day for the rest of my life.
I don't need to loose weight, but I have type II diabetes in a family.
I'm also not vegan - I eat fish and seafood and don't plan to quit.
If a low carb dieter is binging on bread, pasta, rice and bagels, are they really low carb dieters?
Sure, "it's insulin" is a slight simplification. But high insulin promotes fat buildup peripherally AND long term hyperinsulinemia promotes leptin resistance centrally. Both effects tend to increase the "setpoint" (if you think that is a useful concept).
Of course exercise is not useless, I think Taubes has sometimes oversimplified that. But exercise is not as effective for losing weight as most people think. Losing weight by just exercising takes heroic efforts and time, out of reach of most working people with kids at home etc.
Incidentally exercise tends to lower insulin, as glycogen-depleted muscles easily absorbs glucose from the blood.
Some people can certainly lose weight on a low fat vegan diet that as a percentage is high in slow fiber-rich carbs. They usually remove the worst carbs too though: no soda for them usually. A low fat vegan diet based on real food is probably much superior to western junk food, at least if you do not get any deficiencies (like b12).
Humans aren't really rational beings, we are emotional beings. Even though we are more rational than the other animals, we are still much more emotional than rational. If you only believe in what you want you are not only trying fool others your fooling yourself too. It takes practice and effort for most people to think rationally and to be able to ignore your emotions when necessary.
During my long time reading different comments on different diet blogs, I noticed that some people report how they lost weight by just limiting fast food in their diet, or by not eating deserts any more. I have no reason to distrust. Different people have different tolerance for unhealthy diets, and in our obesogenic world people who are probably naturally thin but still manage to collect unwanted pounds, could loose it with very small modification in their diet. For them macro-nutrient content is not as important as for somebody who more incline to be obese. Most obese people can't stay thin on a mixed diet, also they can't eat consistently less on a mixed diet because they are too hungry compare to normal weight people. HFCL diet kills appetite. Why to torture anyone with a hunger? What is the reason to recommend high-carb food over high-fat food, if it is easier to adhere to a LC diet?
It is, indeed, puzzling that the success of a very low carb, adequate protein, high fat diet does not get recommended more often. Clearly, there are people who appear to do fine on other kinds of diets, but there's a significant number of people who are MORE likely to do well with major cutbacks on the carbs. And as Steve Phinney and Eric Westman and Jay Wortman and Ron Rosedale point out so clearly, just asking someone whose hormones are out of whack to exercise more is missing some major ways to get their health in balance.
I hope that someday, a simple and inexpensive test can point out whose metabolism is especially at risk for a high-carb diet. Right now, there's talk about testing children in elementary school for high cholesterol, with implications that it would be helpful to put them on statins. I'd rather see a three-hour sort of "glucose tolerance test" (though hopefully not as severe, in terms of a sugar hit), where both blood sugars and insulin levels are monitored. Probably it would show that children already struggling with weight problems and low energy at those early ages have higher insulin levels that most other kids. And if so, these children should NOT be eating the high carb foods recommended by the food pyramid and the USDA school lunch program. That's my guess. So which would you rather see - a blood test for cholesterol for children or some gentle way to understand their insulin sensitivity? My biggest dream would be a saliva test. For children, blood tests are a little scary.
I do not find that the exercise more does much of anything. I just returned from backpacking in the snow and don't think I lost any weight even while bringing LCHF food to eat. In fact, I don't think I've lost any weight for the past week or two.
The world strives for a one size fits all solution, that is the target of all marketeers of course, its just not possible.
Moderate exercise - like a 3mph walk - as many suggest, really doesn't help much. Vigorous exercise is another story.
I lost quite a bit of weight eating LCHF and adding in vigorous exercise. Certainly, I couldn't exercise vigorously for an hour or two when I started - in fact, I had trouble doing more than a few minutes... but as my fitness improved, my weight-loss accelerated.
I detail my thoughts on exercise in my own blog - I don't know if linking is allowed, but it's LCHFinCanada and it's on blogspot, so you can find it easily enough.
As far as insulin vs. leptin etc. I think different people have different reasons for obesity. That only makes sense. If we were all the same one diet and/or exercise program would work for everyone, and we know it doesn't work that way.
I have Hashimoto's autoimmune thyroiditis, the most common form of low thyroid. For whatever reason, in many this appears to be part of a syndrome affecting the adrenals and often other endocrine glands and even salivary glands and tear ducts, while causing sometimes disabling symptoms. Regarding the topic at hand, many people with Hashimoto's, and almost everyone with low thyroid, gain weight easily and have difficulty losing weight.
In my case before diagnosis and for quite awhile afterward, I had difficulty getting out of bed at all and strenuous exercise made my fatigue far worse. I made sure to get lots of low-impact exercise. But getting anything done, including a living, was challenging already without increased fatigue from running, etc.
To top it off, I reacted to almost every *HEALTHY FOOD* (organic, raw, unprocessed fruit, vegetable, and grain) with increased symptoms. That improved a little after several months of minerals and amino acids targeting the thyroid, plus two months of elimination diet. But I can go straight back to where I was if I eat those *HEALTHY* foods I used to eat, including very much carrots, cabbage, and celery. I am absolutely serious. Regardless, lower carb paleo with most if not all grains eliminated seems to improve gut health, which has been shown to be a big factor in Hashimoto's.
After working on the above for awhile and hydrating more carefully (low blood pressure is another common factor), I began to work up to more strenuous exercise and in some ways felt better than I had since early childhood, though I still have a long way to go with certain severe symptoms.
Last but not least, sometimes it seems like everyone with hashimoto's needs a slightly different diet, as this disease can affect various parts of the body. And you are REALLY lucky if you hear any of this information at all from a doctor, especially* an endocrinologist. In vast numbers, they misdiagnose this disease as depression, perform the wrong tests, and tell patients it's untreatable...or worse.
So while many people choose an unhealthy lifestyle that is pretty much guaranteed to result in obesity and poor health, to assume this is the case with everyone is a mistake. I encourage anyone who thinks they know what causes obesity to remind themselves that their experience could be so far from someone else's that it's like we're different species; and unfortunately the fact that most doctors believe it does NOT make it true.
But at the same time, if they eat too little, they'll catabolize lean tissue instead of burning fat.
It's a balancing act. As such I strongly recommend that people learn what their BMR is and ensure they get enough calories to maintain at least their BMR. From what I'm seeing of my own research, if your caloric intake drops below your BMR requirements (not overall activity requirements, but BMR requirements) that's when people's metabolism slows.
Of course, that's all theoretical - but I'd love to see clinical tests done comparing body composition after a very-calorie-restricted diet vs. a diet that meets caloric BMR requirements... I would be very surprised if those eating more didn't maintain considerably more lean mass while losing just as much weight...
My frustration is with those who only see one way of understanding these complex issues.
This was my experience as well, when I lost a fair amount of weight back in 2004. I had not been active for many years when I started exercising. The first time I worked out on a stair-stepper machine, I had to stop after less than 60 seconds, gasping to catch my breath. Two weeks later, I could use it for 20 minutes without issue. Three months later I could work that stair-stepper for more than an hour without breaking a sweat. The first few steps of any exercise program are always the worst.
That said, I agree that we need to take a proper and balanced approach to exercise. Many exercises burn far fewer calories than we think they do, and many people get into the habit of deciding that since they did some exercise, they can eat as much as they want. I had an uncle who would jog for 30 minutes on Sunday mornings, then come home and have an enormous breakfast. No surprise-- he was around 80 lbs overweight even though he would have claimed that he exercised regularly!
Exercise, done in moderation and with a well-thought out plan, is almost always beneficial. Walking 30 minutes a day won't burn many calories, but it can help you stay in shape as you age. More strenuous exercise may require more time and effort, but it can have a substantial effect on how you look and how you feel. I don't exercise in order to burn XXX calories or so that I can "afford" to eat an extra cupcake. I exercise because I want to feel strong and fit and look my best and because I suffer from arthritis and I do not want to be 60 years old and bent over from pain and unable to walk or open a jar of pickles.
Don't look at exercise as a weight loss pill, and it will serve you well.