The FAT Challenge

There is charm about the forbidden that makes it unspeakably desirable – Mark Twain

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There is truth in that statement.  There is nostalgia, charm, and even romance about sugar.  Sugar is in the memory of your celebrations, your sadness, and your temptations.   It just tastes good!  I do however feel I have sufficiently laid out the reasons why we need to alter our nutritional future and our love affair with the substance.  In this article I hope to point out some the hidden sugars in our live and then help my readers define a diet plan and tips to stick with it for life.

BUT, I DON’T EAT MUCH SUGAR

Yes you do.  You may just not realize it.  If it’s packaged, it likely has sugar.  Manufacturers add sugar to EVERYTHING.  Did you know an 8oz serving of coca-cola has 75mg of SALT?  Why would it need salt at all?  Well because salt makes you thirsty.  So you drink more.  It also has caffeine, which is actually quite bitter, but caffeine is a diuretic so it makes you pee more (which makes you thirsty).  What an awesome product from a business standpoint.  They sell you a drink that they claim is “refreshing” that actually makes you thirstier.  Of course no one would drink a salty, bitter beverage so they add sugar to it to cover it up (sugar is diuretic too by the way).  Manufacturers add salt to lots of things to strengthen flavor and then use sugar to cover the “saltiness”. 

Hidden salt isn't the only story.  Manufacturers know that some people read labels so they have found really interesting ways to say sugar like the following; corn maltodextrin, dextrose, molasses, HFCS, rice syrup, sorghum extract/syrup, and my personal favorite dehydrated cane juice/syrup (dehydrating sugar cane juice is the literal process of making sugar).

An 8oz “serving” of Snapple, Vitamin Water, and Gatorade all have about the same amount of sugar as a serving of coca-cola (about 4-5 tablespoons of sugar).  It’s not healthier it’s just different.  Your average fruit flavored yogurt has 25-30 grams (half of that is added, the other half is lactose).  Last week I almost ate a granola bar that had THREE different added sugars.  I am glad I read the label for that “health food”.

THE PROOF IS IN THE PROTEIN

As many of you know, my hobby is cooking.  I love to cook and experiment with food.  Most of my fondest memories involve the interaction of friends and family around food.  I love to watch people enjoy what I have created.  I also love science.  These two loves have led me to addiction of sorts.  I have a confession to make.  I have a man crush on Alton Brown, the creator of Good Eats on the food network. 

Fans of the show know that Mr. Brown underwent a visual metamorphosis while producing the show.  For those of you that are not familiar with his story, have a look below.

All four of those images are the same person, Alton Brown.  They were taken over approximately 12 months of time.  Mr. Brown didn't like what he saw on camera.  So he, a professional cook, made a diet change.  He didn't hire a personal trainer and fast for weeks at a time.  He just changed WHAT he ate and 9 months later he was 50 POUNDS lighter.  Mr. Brown had this to say:

“Having wrestled with weight my whole life, I knew that a diet based on denial—based simply on don’t do this, don’t do that, don’t eat this, don’t eat that—would ultimately fail for me. I rebel against that. I knew if I was going to design a plan that had any hope of success, it would have to be based on not things I couldn't eat but things I had to eat, because that’s more proactive.   So I came up with this concept that there are a great many foods that are extremely high in nutrition that you ought to be getting every day, some things several times a week. And I balanced that with the things that did need to be restricted…” – Alton Brown

His point is that your diet needs to be something you can live with.  His diet was low in carbohydrates, moderate in proteins, and relatively high in fats, fruits, and vegetables.   I recommend the same, but let’s look at some helpful tips before we get into the specifics of the diet.

LIFESTYLE CHANGE TIPS

The classic “western” diet is designed by manufacturers and food producers to be cheap, tasty, and portable.  It fits our lifestyle so it’s convenient but it doesn't fit the waist band most of us want.    Your stomach is a fuel tank not a waste basket.  I know plenty of people that insist on premium gas for their car but don’t think twice about fast food into their own fuel tank daily.  I strongly recommend you follow these tips:

• HOME CONTROL – Control what is coming into your home!  You and your children can’t snack on unhealthy foods if it isn’t in the house to begin with.  If Ho-Ho’s are around, Ho-Ho’s will be eaten.   (GOAL:  NO IN HOME JUNK FOOD)
• PLATE SIZE –Numerous studies have shown that smaller plate sizes work.  People put smaller portions onto smaller plates.  Studies also show that people tend to leave the same percentage of food on their plate at the end of the meal.  In the 1950’s the average plate size was 9 inches, today its 12.  (GOAL:  SWITCH TO SALAD PLATES FOR MOST MEALS)
• EXERCISE BEFORE MEALS – This one is a little harder.  It takes a little time and effort.  Studies show that our insulin resistance goes down significantly immediately after exercise.  This means you need less insulin release to get the same effect.  Daily exercise at even a light level for 15-20 minutes will increase your basal metabolic rate.  Try to plan a 15-30 minutes of activity before your largest meal.  This could be as simple as picking up the pace of your daily dog walk and moving it to before dinner.  (GOAL:  20 MINUTES OF EXERCISE BEFORE DINNER)
• EAT AT HOME - 70% of meals in America are now eaten outside of the home.  Unless you are brown bagging it you likely are consuming more calories than you should at these meals.  Eating out significantly limits your control over what is in your meal and what your meal options are.  (GOAL:  EAT OUT NO MORE THAN TWO MEALS WEEKLY & PACK YOUR LUNCHES)
• LIVE ON THE EDGE –All the good stuff at the supermarket is located on the edges.  The supermarkets do this on purpose.  They want you to walk through the processed foods (both there and back) to get your milk, meat, and vegetables because processed foods are much more profitable.  The only canned foods I regularly buy are tomatoes and beans.  (GOAL:  SHOP WEEKLY FOR FRESH FOODS ALONG THE EDGE, BUT ONLY SHOP THE AISLES ONCE A MONTH)
• NO SUGAR DRINKS –Eliminate all sugar added drinks.  Limit fruit juices in quantity and drink those that are only 100% juice with no added sugars.   Diet soda drinkers should be aware that newer studies show that artificial sweeteners are linked to almost as much weight gain.  They appear to cause insulin release and may lead to increased hunger as well.  Alcohol has sugars too.  I suggest limiting yourself to no more than SIX alcohol beverages a week.  However if weight loss is your goal, this should probably be closer to THREE a week.   (GOAL:  NO SUGARED BEVERAGES & LIMIT ALCOHOL)
• MINIMIZE FAST FOOD – I would like to say eliminate all fast food, but sometimes it is the only option.  So instead I will say minimize fast food to only once every other week and always because it is the only option convenient.  Never “go-out” for fast food.   Try to make “healthier” choices.  Also I would like to point out that not all fast food is in fact “bad”.  Two grilled fish tacos with lettuce, cheese, and salsa from Fuzzy’s is heavenly, and actually pretty good for you.  (GOAL:  NO FAST FOOD)
• FIBER COUNTS – Fiber improves digestion, fills you up, and naturally helps your blood sugar levels when consumed with fructose.  Try to limit carbohydrate foods to no more than 6-8 servings per week and try to consume most if not all your carbohydrates with natural fiber!  (GOAL:  FIBER WITH ALL CARBOHYDRATES)
• 20 MINUTE WAIT – Food intake takes a while to signal to your body that you are full.  The faster people eat the more they tend to eat.  Start with this simple rule: Anyone (especially kids) can have seconds if they feel they need it but they must wait 20 minutes from the time they finish the first portion.  (GOAL:  WAIT 20 MINUTES) 
• PLAN YOUR MEALS – Dietary changes fail because we set up ourselves for failure.  We restrict too much, we make unreal goals, and most importantly we fail to plan.   If you don’t plan out your weekly meals in advance you will be throwing away a lot of produce and defaulting to pre-processed “quick” meals.  Sunday afternoon is a great time to prep several meal items for the week.  (GOAL:  MAKE A WEEKLY MEAL PLAN & SHOPPING LIST)

THE DIET I RECOMMEND

So, when it comes to eating healthy, it's just doing the right thing. And it's not something you have to do 365 days a year, but I think it's something you have to do 25 days a month. Let's put it that way. - Mike Ditka

That is sound advice.  It’s not about every day, it’s about most days.  Desserts are a huge source of extra calories.  If you are going to have a drink, consider it your desert.  A small desert is often better than depriving yourself of one and then having 3 scoops of ice cream the next day.  

DO                                

• Lean meats & eggs (30-35% of diet)
• Fresh/frozen & cooked vegetables & legumes (45%)
• Fresh & frozen fruits (10%)
• Potatoes – limit 1-2 times weekly
• Pasta or rice – limit 1-2 times weekly
• Whole wheat breads – limit to 1-3 times weekly (never with another carb)
• Olive, canola, grape seed oil, or butter
• Low fat milk and Greek yogurt
• Cheese (limited)
• Nuts and seeds

DON'T

• Bread with meals
• Processed baked goods
• Non-whole grains
• High fructose corn syrup
• Added sugar & sweet beverages
• Fried foods and fast foods
• Margarine
• Most canned items

Check out this new research on the Mediterranean Diet too!

THE FAT CHALLENGE

Finally we get to the challenge.  I am asking my readers to consider sticking to my dietary advice for 6 weeks.  If you are willing to keep a food journal (basic items eaten and estimated amount) as well as let me know your starting, mid, and ending AM naked weight, please contact me at bellenbecker@live.com.  I too will be joining you in this quest and hope to post some results (anonymous) in April.  I am confident that if you stick to my plan you will not only lose weight but likely feel better as well.

MENU IDEAS:

• Breakfast
• Egg Muffins
• Quick-cook steel cut oats with 1 tablespoon brown sugar and raisins 
• Plain Greek yogurt with homemade berry sauce (1-2 tablespoons)
• Berry Sauce: (1 cup fresh berries, blend to desired consistency.  Sweeten with a little honey if too tart)
• Lunch
• Mixed green/spinach salad with fresh vegetables and scoop of chicken or tuna salad
• Left-overs in smaller portions  from night before (if you eat right this is quite healthy)
• Spinach, Swiss, and turkey on whole wheat tortilla wrap or bread
• Dinner
• Pork
• Sear 2-4 center pork chops on each side and remove from heat.  Saute onions and garlic in pan.  Add can of Rotel and reintroduce pork chops and 1 sliced zucchini.  Simmer 10-20 minutes
• Serve with avocado salad:  Diced avocado, tomatoes, red onion and one can black beans
• Chicken
• Bread Chicken breast (I often use chicken tenderloins) in freshly grated Parmesan and panko bread crumbs (egg wash) with seasonings of choice.  Bake in oven at 325 until done
• Serve with Alton Brown’s cauliflower & cheese and fresh green beans
• Steak
• Marinade and grill steaks
• Serve with mushroom ragout and roasted brussel sprouts
• Salmon
• Place salmon fillets in oven safe glass container.  Add 1/4 cup white wine, pepper, and a dash of dried tarragon.  Bake on 350 for 16-18 minutes 
• Serve with sauteed asparagus and orzo pasta with pesto (1/2 cup cooked)

Check out the other three parts:  The FAT In Me, The FAT In Sugar, and The FAT In You

The FAT In You

This is the third of four blog entries designed around educating my readers on the latest knowledge on nutrition and obesity.  Up to this point we have discussed my own personal problems with weight gain as well as the causes of weight gain (SUGAR).  In this article we will look a little deeper into the associated problems with weight gain and how they affect all of us.

Why is all this sugar stuff important to me?  Well, because I am a dad to a beautiful boy and soon another child as well.  I care quite a bit about his future.  I was alarmed to find out that nutritionist now expect that my son’s generation is not projected to outlive my own (their life expectancy is less).  That’s sad and unprecedented in modern times.  At least his generation can feel good that their poor health will vastly improve the fiscal solvency of social security and medicare for their own children’s generation.  For those that haven't read the previous articles please check out:  Part 1:  The FAT In Me and Part 2:  The FAT In Sugar before following along while we take a closer look at some more of the science behind obesity.

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THE HORMONES MADE ME DO IT

When nutritionists talk about hormones they aren't talking about estrogen.  They are talking about insulin, leptin, ghrelin, and cortisol.  Lets take a closer look:

INSULIN –  This is the mother of all dietary hormones.  Insulin is released from the pancreas in response to blood sugar levels.  Insulin has one job. It allows for the uptake of glucose from the blood stream into the tissues where it can either be burned or converted to fat. 

 INCREASED SUGAR = INCREASED INSULIN = INCREASED FAT STORAGE.

As Americans have slowly increased their sugar intake, their release of insulin has also increased leading to higher insulin levels.  The tissues of the body respond to higher insulin levels by increasing insulin resistance because they don’t need or want the extra sugar but the pancreas is a stubborn organ and it really wants to get it out of the blood stream.  Increased insulin resistance is the hallmark of Type II diabetes.  The pancreas senses the increased resistance and it continues to push out more and more insulin until it essentially burns out.  This state is known as insulin dependent diabetes.

LEPTIN – Leptin is released from fat after eating and signals the brain that you are full.  The fatter you are the more leptin you produce.  In theory this should make fat people eat less, however leptin is blocked from signaling your brain by insulin.  So if you circulating insulin levels are high (as they are in most obese people) then leptin can’t do its job.

GHRELIN – Ghrelin rises when we are hungry and goes down after we have fed.  Interestingly obese people have lower levels which would make one think that they are hormonally “less hungry” however that may not be how ghrelin really affects weight, because ghrelin is also involved in our reward system.   It causes dopamine to be released in the reward area of our brain which is what drives the sensation of pleasure.  The good feelings you have after drinking alcohol, smoking tobacco, having sex, and yes, eating sugar, are all due to dopamine and ghrelin helps that out.  This system is blunted in the obese so they actually get less reward for the same pleasurable stimulus!  That’s right, thin people enjoy their “addictions” more than fat people do.  (that just makes me angry)

Incidentally, this dopamine pathway likely helps explain why buproprion (a common anti-depressant) has been shown to be weight neutral to actually weight negative.  It works by prolonging the exposure of dopamine in your brain.

CORTISOL – Cortisol and stress are best buddies.  When stress goes up, cortisol goes up with it.  When cortisol levels rise in most people, their response is to eat.   And they preferentially crave fat and sugar.  We are not sure exactly why this is, but scientist theorize that this may be the natural reaction of our body to early forms of stress (starvation/illness).  It stands to reason that if the body suspected metabolic stress it would do what it could to prepare for it by gathering resources (fat) for the future.

SUGARS WITHOUT FIBER

At least a few times since starting my knowledge quest on nutrition I have had people say to me “but fructose is fruit sugar, its natural”.  This statement has two bits of faulty logic.  1)  The belief that natural is healthy.  There are lots of things in nature that will kill you.  Being naturally occurring has nothing to do with being healthy for you.  Cocaine, arsenic, and tobacco are all naturally occurring and pretty bad for you.   2)  The belief that all fructose is equivalent.  In the liver, fructose is fructose, enough said.   However how it gets there is vastly different.  Almost all naturally occurring fructose is conveniently packaged in nature with a whole lot of FIBER.  Fiber speeds up transit in the gut which leads to less absorption of fructose as well as stimulating an earlier satiety signal to the brain which helps you to stop eating.  Added sugar, fruit juices, and HFCS are rarely packaged by companies with fiber.  This is because soluble fiber attracts moisture and reduces the shelf life of products while insoluble fibers add bulk (weight) to an object without improving taste (cost more to produce without increasing sales).

I WAS MADE THIS WAY

The scary part about all of this knowledge is that we may already be genetically programmed to be fat.  We are born with all the fat cells we will ever have.  How big they become is largely dependent on our diet but the total number is decided while we are in the womb.  Insulin is what causes the production of fat cells in the fetus.  So if mom had higher base levels of insulin from years of excess sugar consumption then baby is more likely to have more fat cells at birth!  We know this is true because mom’s with gestational diabetes have much heavier babies on average.  We also know that the birth weights of today’s children are much higher than past generations and this is largely attributed to larger weight gains in pregnancy and higher circulating levels of insulin! Depressing isn't it.  Well it gets worse.  For most of the 60’s, 70’s, and 80’s we had a huge decrease in breastfeeding and huge increase in formula feeding of babies.  Some mom’s don’t have a choice between breast or formula, but a lot do.  A lot choose formula.  Well guess what.  A 100ml serving of liquid formula has between 11-12 grams of sugar.  The same size serving of breast milk is 7-7.5 grams!  We are training our babies to crave sweeter substances right from birth.  

ALL THOSE BAD THINGS

In the last article I mentioned that sugar and fructose in particular can lead to a lot of bad things.  We already talked about diabetes and obesity but ponder these as well:

BLOOD PRESSURE & ERECTILE DYSFUNCTION – Fructose breakdown requires nitrous oxide (NO) utilization.  NO is our natural dilator of blood vessels.  With less around we have more vasoconstriction leading to higher blood pressure.  NO is also needed to achieve and maintain an erection (Viagra works by helping NO bind to another substance).  Less NO means less erection.

HIGH CHOLESTEROL – Fructose breakdown also produces VLDL, the worst kind of LDL or “bad cholesterol”

GOUT – Fructose breakdown also produces uric acid which will form gout crystals if levels get to high

POLYCYSTIC OVARIAN SYNDROM & INFERTILITY – increased insulin leads to increased body fat which leads to PCOS in women.   PCOS patients have deregulation of their hormone axis leading to infertility.  PCOS patients are sometimes treated by giving them a diabetes drug (metformin) which actually makes your tissues more sensitive to insulin and thus potentially decreases your circulating insulin levels!

DIABETES à VASCULAR DISEASE à STROKE & HEART ATTACK – Just a reminder

ALZHEIMER'S - And just to upset my older readers I thought I would point out this article, which showed a tendency toward higher rates of Alzheimer’s in those with carbohydrate heavy diets.  

ABOUT THAT EXERCISING

My latest writings have been almost solely focused on nutritional changes, and in particular sugar reduction.  I do not want people however to ignore the benefits of exercise.   Exercise does burn calories.  Intense exercise may not burn as much as I previously thought when compared with light exercise but it definitely does burn calories and a whole lot more than no activity at all.  You can estimates calories burned per mile of running (0.75 x weight) versus walking (0.53 x weight) and clearly see a difference.   Exercise has other added benefits as well.  Exercise improves skeletal muscle insulin sensitivity (also what the diabetic drug metformin does) which allows your body to produce less insulin to produce the same effect.  Less insulin is a good thing.  Exercise reduces stress which leads to lower cortisol production which reduces both blood pressure and appetite.  Finally, exercise increases your bodies metabolic pathways (TCA cycle runs faster) which increases liver insulin sensitivity and decreases the conversion of fructose to fat!  So please, don’t stop exercising!

Hopefully by the start of next week I will have finished part four where I will discuss hidden sugars, diet tips, the diet I recommend, and even some sample menus in the final installment:  The FAT Challenge.  Until then consider buying one of these two books.

• FAT CHANCE:  Dr. Robert Lustig
• WHY WE GET FAT:  Gary Taubes

The FAT In Sugar

 “What if how much you eat and how much you exercise is much less important than WHAT you eat?  What if what nutritionist and dietitians (and thus the doctors they teach) have been wrong for the last 25 years?”

That was the end of my last post.  If you are reading this and you have not read part 1: The FAT In Me, Please do so.  Let’s take a look at what I was getting at.

Three weeks ago a simple dietary question started me on an exploration of the diet world as well as current trends in nutrition.  During the process I came across a lecture from 2008, SUGAR: THE BITTER TRUTH, by Dr. Robert Lustig.  This lecture, along with several follow-up lectures and articles has led to my new nutritional awareness. 

Dr. Lustig is a very well-known and respected physician who is an expert on treating obesity.  In his lecture he presents, in my opinion, near indisputable evidence that the cause of most obesity in this country is in fact SUGAR.  In particular, it is the sugar fructose that he implicates as the white devil.  We know that increased caloric intake leads to obesity and diabetes.  However, Dr. Lustig shows that when the PERCENTAGE OF CALORIES FROM SUGAR goes up but calories remain the same, the correlation to diabetes and obesity because much more pronounced!  Dr. Lustig shows IT'S NOT JUST THE CALORIES, ITS SUGAR CALORIES.

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I am not one to fall for the latest fad research topic so I did my due diligence to both myself and my patients and began to research this topic at length.  I warn you though, it is hard to ignore what Dr. Lustig is getting at given he provides ample scientific proof.  What I found is that most nutritionists now agree with him.

You can probably get more out of watching his lecture than reading my synopsis but I will try to make it a lot easier to understand.  Let’s first explore metabolism.  

Our bodies need fuel to run.  We take in fuel in the form of food and break it down through various processes to form energy.  This “fuel” comes in one of three forms:  FAT, PROTEIN, or CARBOHYDRATES. Let’s take a closer look at each component and the diets based on those components. 

FAT: 

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Dietary fats (triglycerides) are broken down in the gut and converted into fatty acids.  These fatty acids are then further manipulated before going to various tissues of the body.   The cells can then either burn them for fuel or store them as fat. 

Here lies the principle of the low fat diet (ADA, USDA, DASH).  In theory if we take in less fat we will have less fat to store.  Seems sound, but the evidence doesn’t show it.  I have plenty of obese patients that eat low fat diets.  According to research described by Dr. Lustig, the average American has reduced the percentage of fat in their diet by 10% over the last 30 years (From 35% to 25%) yet we continue to get fatter.  Meanwhile the percentage of calories from carbohydrates has continued to rise.

Low fat diets have some flaws.   Fat consumption leads to earlier satiety than protein or carbohydrates and generally foods that are higher in fats tend to taste better as well.  These two principles make low fat diets difficult to stick with.  Also studies show that when people embark on diets that are low in fat, they will replace the missing calories most often with carbohydrates rather than protein either purposely or unintentionally.  We will get to why this is bad in just a little bit.

PROTEIN:

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            Protein metabolism is much simpler to explain although the process is actually rather complex.  When protein is ingested it is broken down through a number of processes into amino acids.  Amino acids can then be used to either directly to form cellular energy or can be converted to glucose in a process called gluconeogenesis.  This process occurs only in very minute amounts unless blood sugar is low.  This is the concept behind the high protein diets (ATKINS, ZONE, SOUTH BEACH).  The super low levels of carbohydrate drive down blood glucose levels which drives your body to look preferentially to protein and fat as energy sources.  In general these “dieting” techniques are actually quite effective but they tend to produce a lot of bad byproducts and they are very hard to stick to long term.

CARBOHYDRATES:

            Carbohydrates are essentially sugars.  They come in many forms but in the end they all get broken down into one of four basic monosaccharaides (sugars).  Since glucose and fructose are far more common than the other two, we will focus on them.  There are not many high carb diets although the ORNISH diet is one that is high in “low glycemic index” carbohydrates while being very low in protein and fat.  The ORNISH diet is also usually calorie restricted and is extremely high in fiber while being relatively lower in fructose.   

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GLUCOSE – Is the essentially sugar on which all animals function.  An example would be the natural sugars found in a slice of bread.  Your body readily consumes glucose as energy.  In fact 80% of the glucose you eat is burned off.  The other 20% is transported to the liver.  During processing of the liver portion, 30% of this will be converted to fat regardless of your activity level.  However a very high activity level could then lead to fat breakdown for increased energy need.

            FRUCTOSE – Fructose is the sugar found naturally in most fruits.  It is also found in High Fructose Corn Syrup (HFCS) and table sugar.  Fructose is much sweeter than glucose.  Your body can not readily use fructose thus 100% of all fructose consumed must be broken down in the liver.  Like glucose, 30% of the liver metabolized portion will be converted to fat. 

Let’s take a look at what I just said via a mathematical example:

Glucose Breakdown (120 calorie sample): 

• 96 calorie burned (80%) à 24 calorie to liver (20%) à 7.2 calorie to FAT (30%)

Sucrose Breakdown (120 calorie sample, 50% fructose): 

• 60 calories glucose à 48 calorie burned à 12 calorie to liver à 3.6 calorie to fat
• 60 calories fructoseà 0 calorie burned à 60 calorie to liver à 18 calorie to fat
• 18 + 3.6 = 21.6 calories to FAT

HFCS (120 calorie sample, 55% fructose): 

• 54 calories fructose à 43 calorie burned à 11 calorie to liver à 3.3 calorie to fat
• 66 calories fructoseà 0 calorie burned à 66 calorie to liver à 20.4 calorie to fat
• 20.4 + 2.1 = 23.7 calories to FAT

WOW!

The math demonstrates Dr. Lustig’s key point; while all calories are in fact calories, they do not all behave the same in the body.   Even more important is the realization that FRUCTOSE is making us fat.  An alarmingly large amount of the fructose you consume is directly converted to fat during processing. 

Sadly, fructose consumption continues to rise.  Early humans consumed around 15 grams of fructose a day, almost all of which was packaged with natural fibers to delay digestion and absorption (This decreases the percentage of the fructose that is converted to fat).  Fructose in the American diet has almostdoubled from 37 grams a day in the 1970’s to well over 60 grams of fructose daily!  

Everything I just wrote boils down to this:  SOME people get fat because they eat too many calories and exercise to little.  However MOST people get fat because they eat the wrong kind of calories.

Check back in another week or so when I following up with part 3 of the series:  The FAT In You!  

The FAT In Me

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I’m fat.  F A T.  It’s sad really.  I give advice to people every day about weight loss, exercise, and diet.  Yet I’m fat.  I am not always a follower of my own advice.  This is also not a new development.  I weigh 203 pounds.  I am 70” tall.  That works out to a BMI of 29.1.  As a physician, I know that means I am overweight (BMI of 25-30).  Just for reference, the ideal weight of a 5’10” average framed male is 165lbs or so.   I have struggled most of my adult life with weight control.  I like to cook, like to eat, and definitely like to enjoy my wine.   I have always felt my problem is that I “like” too much.  I overeat.  In fact I have always looked at weight gain as being either an issue of overeating or lack of activity.  Overeater's generally come in two varieties:  1) people with relatively healthy diets but who consume to much of it (too much of anything is bad);  2) people who only eat 2-3 times per day but choose to eat fast foods, fried foods, and packaged meals (garbage in = garbage out).

 

My Data:

AGE	WEIGHT	HEIGHT	BMI
17	165	68	25.1
18	160	69	23.6
22	225	70	32.3
24	175	70	25.1
26	205	70	29.4
29	195	70	28.0
30	210	70	30.1
31	180	70	25.8
33	203	70	29.1

That is my actual life data.  Since finishing puberty (I was a late bloomer) I have had but one very short period of my life when I would not have been considered by medicine to be overweight.  A visual inspection however would likely have not agreed.

Sadly, most of patients wouldn't say that I am fat.  Some may say I am “little” overweight.  In actuality though, most of us are fat.   In fact the average American is 25lbs heavier today than they were 30 years ago.   And it’s not just the very obese that are skewing the data.  Even thin Americans are fatter than they use to be.  A Gallup poll done over the last 20 years shows that our weight has gone up by roughly 20lbs during that period but more alarming is that our perception of whom is fat (or rather what we think is ideal) has also gone up by over 10!  It appears that much like beauty, FAT may be in the eye of the beholder.

Obesity has been present throughout history but on a whole the average weight of Americans has been going up since the 1940’s but the rate at which we are getting fat has rapidly increased since 1980.  Most medical literature, including the conclusions of this study, noted this to likely be due to a general shift to a more sedentary lifestyle (a shift away from the farm and to the city).   However that doesn't quite make sense does it?  Suburbs have existed as far back as the 30’s and 40’s.  America did not see a massive decline in the farming population in the 70’s.   In fact that move occurred much earlier (30’s).  USDA states on their site that Urban Americans have outnumbered rural Americans since the 1920s!  Also, it is important to point out that not all farmers are heavy workers.  It doesn't take a great deal of physical effort to grow crops since the advent of the tractor and harvesters. 

Energy use by people has declined and that most likely has been part of the problem but is it all?  Ask yourself this question:  Did my grandparents ever go to the gym or for a run?  Fast food has also been listed as a cause and no doubt contributes as well but remember than most fast food chains have been around since the 1960’s and there are plenty of fat Americans that almost never eat fast food.

The weight gain mantra is that increased weight is due to either a lack of exercise or an overabundance of intake.  In fact that is what I and most doctors are taught in school.  For years we have thought of weight gain by this equation:

Change in weight = Calories In – Calories Out

The national institute on health even preaches this mantra on their webpage here.  This is so ingrained in medical teaching that until very recently one would be laughed out of the building to suggest otherwise.  But what if that isn't true? 

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What if how much you eat and how much you exercise is much less important than WHAT you eat?  What if what nutritionist and dietitians (and thus the doctors they teach) have been wrong for the last 25 years is wrong?   Everything they have taught you would also be wrong!

Over the last few weeks I have spent an incredible amount of my free time reading about that very question.  I learned that the Paleo diet may just be better than I thought.  I learned that not all calories are created equal.  And I learned that obesity is much more than a problem of abundance.  Later this week I will share my findings and hopefully be able to offer up some decent medical advice as well.  

 

The research seems to say that weight isn't a simple mathematical equation.  What type of calories you consume may be more important long term than how much your consume or how much you burn off.

For the scholars among my readers I highly recommend you check out the following which will be the basis of my next post:

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• Sugar:  The BitterTruth – 90 minute lecture that just blew my mind (its the 10th video)
• Sugar:The Bitter Truth (short version) – 12 minute summary of above by a fan

• The Skinny on Obesity – A collection of 5-10 minute videos breaking down the above lecture
• Calories vs. Carbohydrates – 35 minute lecture on why not all calories are equal
• Is Sugar Toxic – NY Times article by the author of Calories vs. Carbohydrates that brings it all together

On to Part 2:  The FAT In Sugar