Weigh In On the Matter, Will Ya?

Weight.  People are obsessed with weight.  Everyone wants to be thin, to lose an extra 5-10 lbs.  Your doctor probably tells you (maybe) to lose 10 lbs every time you go in for a checkup.  When medical professionals counsel patients, they always suggest losing weight.  In fact, in those with hypertension (i.e. high blood pressure), losing weight results in a 8-20 mm Hg drop in blood pressure.  Losing weight is in fact more effective than most blood pressure medications (and that's coming from a pharmacist).

However, how does one lose weight?  Ask your doctor and most likely he'll say to reduce your fat intake for health, eat whole grains and lean meat, fruits and vegetables and exercise.  You know, simple.

Modern science says that if you reduce the your calorie intake while increasing your energy expenditure that you'll have to lose weight.  In fact, you can't help but lose weight.  So people endlessly jog, climb stairs, Crossfit, bike and whatever other self-inflicted physical tortures they think help tip the equation in their favor.  And, they cut the fat.  Fat has more calories per gram (10 Calories/gram) than carbohydrate does and we're told it causes heart disease anyway so it should be reduced.  In fact, the American Heart Association recommends that saturated fat should be no more than 7% of our diet.  All in all, weight loss is just an exercise in the simple laws of thermodynamics.

Or is it?

The trouble with this central tenet of science, the infamous calories-in calories-out hypothesis, is that it actually isn't true.  It's an oversimplification of biology.  We are designed to have a energy reservoir on hand for the extended periods of times when food is not available.  That chosen energy reservoir is fat.  In fact, 10 lbs of fat packs enough energy for someone to be able to run 13...marathons.  Not miles, marathons.  That's a lot of energy!

The other problem with the calories-in calories-out hypothesis is that it supposes we can reduce calorie intake and our biology will not respond with a drop in metabolism rate.  Likewise, if we increase energy expenditure by power lifting in a Crossfit competition or running a 5k, our general metabolism shouldn't increase.  The key point is: our metabolism and energy intake will balance each other out...always.

The real equation is not the calories-in calories-out that everyone thinks it is.  The real equation that matters is:

Fat Transferred into Fat Tissue for Storage = Fat Transferred Out for Energy

This is the equation, the whole enchilada.  There is a complex set of hormones that control how fat enters into fat tissue and is stored as well as how it is released and used for energy.  

When a person with a normal metabolism hasn't eaten in 12 hours, they will quite easily transfer fat out of their fat cells into the blood stream to be used for energy or be converted in the liver into glucose.  Glucagon, a hormone that's secreted by the pancreas when your blood glucose level is low, stimulates your fat cells to give up their fat.

So, what stimulates your fat cells to take up and store fat?  Well, insulin does.  Yes, the hormone involved in lowering your blood sugar also is the hormone that stimulates fat uptake.  Insulin...makes you fat.  What stimulates high levels of insulin will thus force the above equation in the fat storage direction.  Insulin responds directly to the level of glucose taken in in the diet.  In addition, the faster the glucose is absorbed (i.e. refined carbohydrates, potatoes, sugar, high fructose corn syrup) into the blood stream, the higher the insulin response.  

Insulin is a critically important hormone as high sugar in the blood (hyperglycemia) is toxic.  People with type I diabetes whose pancreas produces no insulin suffer from serious problems associated with high sugar.  Traditionally, humans have never been exposed until our very recent history to the levels of easily digestible and rapidly absorbable (and therefore highly insulinotropic...insulin stimulating) carbohydrate.  In fact, you'd need to eat 8 feet of sugar cane to consume the amount of sugar contained in one 12 ounce Mountain Dew.  Obviously, technology has made what was impossible task (consuming 8 feet of sugar cane) quite possible.  

So, where do go from here?  How do we lose weight?  Well, to lose weight, we need to make fat stored away freely available for energy consumption.  The problem with low calorie diets recommended by health care professionals for weight loss, in fact the problem with the American diet in general, is that it is a high protein, low fat, high carbohydrate diet.  A calorie is not a calorie.  Easily digestible and absorbable carbohydrate causes spikes in insulin to correct the toxic sugar load.  Insulin then prevents release of fat from fat tissue and in fact stimulates fat tissue to get larger.  After repeatedly eating such types of meals, a person will start to become insulin resistant (prediabetic) and require larger and larger doses of insulin from their pancreas lower the same amounts of absorbed sugar.  The low calorie diets people go on to lose weight are high in sugar and carbohydrate which still stimulates insulin.  Insulin blocks release of fat.  

All of this drives insulin higher and higher, forcing fat into your fat cells.  In addition, it prevents the release of fat.  Because you don't have easy access to your stored fat, those with obesity and insulin resistance are actually legitimately starving.  Low calorie high carbohydrate diets that stimulate large levels on insulin with make you ravenously hungry.  In fact, high calorie diets that are really high in carbohydrate will make you hungry too.  It's as though their body thinks they are not eating.  It responds by slowing down metabolism and energy expenditure.

Obesity, prediabetes and insulin resistance CAUSES reduced energy expenditure, inactivity and hunger/overeating.  Overeating and lack of activity DOES NOT CAUSE obesity.

What is the solution?  Well, we have an essential requirement for protein and fat.  In fact, we cannot survive without a diet adequate in both.  However, carbohydrate is nonessential.  In other words, 60% of our USDA food pyramid can be thrown out the window.  Cutting out pasta, bread, all forms of sugar and sweet beverages, potatoes, cereals, etc will almost immediately decrease chronically elevated insulin levels.  Keep in mind that if you remove those calories without replacing them that you'll simply be eating a low calorie diet.  For maximal health, you need to replace those calories with fat.

And remember...your diet is not just calories.  It's nutrients.  It's vitamins, and minerals.  It's important to take in adequate amounts of nutrients along with calories.  

This is a complex subject matter.  I hope I distilled it into something very basic and workable.  I'll leave you with this thought.  Perhaps the best treatment for type II diabetes and obesity is not insulin as insulin seems to be quite toxic and disruptive.  Perhaps, it's carbohydrate restriction...

My Story - Just the Facts, Ma'm

Hello reader.  I've decided to undertake a new project.  In the midst of a very busy time in my life, this could downright be the worst idea in the world.  I may furiously blog for a few weeks, then go radio silent for a few weeks to months, and the pop back up again because I realized I haven't written in awhile.  It's good showmanship to keep the fans waiting.  Just not too long.

Right then, let's delve into why I'm writing this.  I've been wandering a forest for some time now and only recently have I felt like I've come to a clearing.  You know, one of those clearings where you can see the rolling hills covered with the forest you've been lost in for so long.  Now that I can see things a little more clearly, I can at least attempt to give myself, and perhaps you, more direction.

Okay, you're probably wondering what the hell I'm talking about.  Well, it all starts with a simple question.

What is the ideal diet for man?

Everyone has an opinion about this.  In fact, you go anywhere in the world and ask such a question a million times and you'll get a million different answers.

First off, you need to realize I'm already pretty far along in my journey to answer this question.  Remember, I'm in the metaphorical clearing as I mentioned.

A brief history of Steve:

As a kid, I ate a normal complement of what modern day food bloggers and scientists call the Standard American Diet (SAD).  From cereal for breakfast to the carbohydrate heavy mexican pizza for school lunch to the spaghetti and meatballs for dinner always with some kind of soda, my diet was awash in processed carbohydrates and sugar.  It's just how I ate, how my family ate.  It's in fact how most families eat.  Granted, I did have access to fresh fruit, vegetables and good meat as well.  I was never overweight.  My sister and I remained a normal weight despite what I've come to believe is a poor diet.  However, despite this, I suffered from what are the other consequences of a diet that promotes insulin resistance.  I had terrible acne and rapidly became nearsighteded (myopia).  Out came the benzyl peroxide creams and eyeglasses in my early teens.

Fast forward through high school, undergraduate school and finally onto pharmacy school.  My acne had cleared up only because of a rather toxic drug called Accutane.  I made it to 5 months before it started messing with my liver but, amazingly, my acne was clear for the first time in my life.  I was still, however, nearsighted and I was still 5'10 and 150 lbs, like I've always been.

Blood pressure lab.  Yes, we pharmacists learn to take manual blood pressures as the machines you seen in a pharmacy can be notoriously inaccurate.  My diet still consisted of no breakfast, pizza for lunch and, most of the time, some kind of terrible fast food for dinner.  I was 23.  I was fit.  I lifted weights and ran.  My blood pressure was 150/100 mm Hg.  For those who don't know, that's Stage I hypertension (and maybe stage II).

The last year of pharmacy school is when we do our clinical rotations.  My first rotation was in New York City.  I was still 5'10, still 150 lbs.  Perfect Body Mass Index (BMI).  I never walked so much in my life. In NYC, you do an incredible amount of walking.  Just to get to the subway could mean a mile of walking.  I increased the amount of exercise I was getting dramatically.  I also took to having a iced coffee with sugar in the morning from Dunkin' Donuts, chinese food for lunch and usually some kind of pizza for dinner.  Sometimes it was a sandwich.  You know, to stay healthy.  In general, however, it was pretty bad food.  Thirty days later, despite a serious increase in my activity given the amount of walking I was doing, I gained 25 lbs.  I was 175.

Years of being at 175 passed.  I knew all that weight gain wasn't muscle mass.  I continued to eat the same way I always had and my weight stayed pretty steady.  I couldn't really lose it.  At work, I'd occasionally measure my blood pressure on those notoriously inaccurate machines.  It'd squeeze my arm and blink back some number like 155/100.  Maybe I was stressed?  Was it normal for a 28 year old to have this kind of blood pressure?  I finally started seeing a doctor after I graduated.  I figured it'd be the responsible thing to do.  My blood pressure was usually elevated and my lipid profile sucked.  My LDL cholesterol was always high but more importantly my HDL was always low and my triglycerides were always above 150.

But, I was active, wasn't gaining weight and so I didn't give it much of a thought until I met my now wife.  She's a physician with a strong interest in nutrition.  And, since I'm stubborn, it has taken me awhile to come around to the idea that perhaps a steady diet of government chees...errr...fast food from subway, sodas, pizza and the like will put me in my grave before I'm 50.  Luckily she's a great cook.  I started slowly, making myself breakfast for the first time ever, trying to exercise, bringing leftovers for lunch and experimenting with various diets (vegetarian, vegan, whole foods, etc).  It's been a journey for me that has culminated into a personal philosophy of eating that I am hoping I can share with you.

I'm now back to 150 lbs.  What's critically vital for everyone to know and understand is that I lost that weight through no extraordinary calorie reduction.  In fact, before I lost the weight, I never ate breakfast.  Now, I eat large, calorie dense breakfasts.  I eat far more calories now than I did before.  It's not the total calories.  IT IS THE TYPE OF CALORIES consumed.  My blood pressure has much improved, my lipid profile is back to normal and I do not count calories.  I never have.  I eat when I'm hungry (usually three times a day like normal people) and eat until I'm full.  It wouldn't surprise me if I ate 2500 calories a day.

The ideal diet does one and one thing only:  it makes  keeps people insulin sensitive.  Any diet that stimulates you to produce insulin in rapid, large quantities will lead to something medicine calls hyperinsulinemia and insulin resistance.  Insulin in and of itself is the main player.  The target.  The whole enchilada.  The generally helpful hormone with a complex array of purposes that our SAD way of eating has commandeered and forced to work way behind what it was meant to do.  Even if you don't have diabetes, you still could be insulin resistant and so still, in my opinion, at risk for the modern ills of civilization: diabetes, coronary artery disease, cancer, etc.

As a note about me, I'm like I said a pharmacist with an undergraduate degree in biochemistry.  My training and studying has prepared me for only one thing:  how little I actually know.  I'm very much a scientist at heart and I don't believe anything unless there are a set of good observations/data behind it.  Having said that, it's important to and sometimes very difficult for people, especially in medicine, to understand the limits of their own data.  I feel over the last 50 years that we've been lead astray by well meaning people who tried to create mass societal experiments without the data to back it up.  Science as a whole, has seen players who have and continue to challenge the status quo, the dogma, the accepted truth.  And so I say to you, anything that I say has been my own personal experience is not in any way meant to be medical advice.  It is a culmination of a lot of reading and experimentation.