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Prevention is Easier than Cure
Experiments in animals have confirmed what common sense suggests: it’s easier to prevent health problems than to reverse them. Still, many health conditions can be improved, and in some cases reversed, through lifestyle interventions. It’s important to have realistic expectations and to be kind to oneself. Cultivating a drill sergeant mentality will not improve quality of life, and isn’t likely to be sustainable.
Fat Loss: a New Approach
If there’s one thing that’s consistent in the medical literature, it’s that telling people to eat fewer calories does not help them lose weight in the long term. Gary Taubes has written about this at length in his book Good Calories, Bad Calories, and in his upcoming book on body fat. Many people who use this strategy see transient fat loss, followed by fat regain and a feeling of defeat. There’s a simple reason for it: the body doesn’t want to lose weight. It’s extremely difficult to fight the fat mass setpoint, and the body will use every tool it has to maintain its preferred level of fat: hunger, reduced body temperature, higher muscle efficiency (i.e., less energy is expended for the same movement), lethargy, lowered immune function, et cetera.
Therefore, what we need for sustainable fat loss is not starvation; we need a treatment that lowers the fat mass setpoint. There are several criteria that this treatment will have to meet to qualify:
- It must cause fat loss
- It must not involve deliberate calorie restriction
- It must maintain fat loss over a long period of time
- It must not be harmful to overall health
I also prefer strategies that make sense from the perspective of human evolution.
Strategies: Diet Pattern
The most obvious treatment that fits all of my criteria is low-carbohydrate dieting. Overweight people eating low-carbohydrate diets generally lose fat and spontaneously reduce their calorie intake. In fact, in several diet studies, investigators compared an all-you-can-eat low-carbohydrate diet with a calorie-restricted low-fat diet. The low-carbohydrate dieters generally reduced their calorie intake and body fat to a similar or greater degree than the low-fat dieters, despite the fact that they ate all the calories they wanted (1). This suggest that their fat mass setpoint had changed. At this point, I think moderate carbohydrate restriction may be preferable to strict carbohydrate restriction for some people, due to the increasing number of reports I’ve read of people doing poorly in the long run on extremely low-carbohydrate diets (2).
Another strategy that appears effective is the “paleolithic” diet. In Dr. Staffan Lindeberg’s 2007 diet study, overweight volunteers with heart disease lost fat and reduced their calorie intake to a remarkable degree while eating a diet consistent with our hunter-gatherer heritage (3). This result is consistent with another diet trial of the paleolithic diet in diabetics (4). In post hoc analysis, Dr. Lindeberg’s group showed that the reduction in weight was apparently independent of changes in carbohydrate intake*. This suggests that the paleolithic diet has health benefits that are independent of carbohydrate intake.
Strategies: Gastrointestinal Health
Since the gastrointestinal (GI) tract is so intimately involved in body fat metabolism and overall health (see the former post), the next strategy is to improve GI health. There are a number of ways to do this, but they all center around four things:
- Don’t eat food that encourages the growth of harmful bacteria
- Eat food that encourages the growth of good bacteria
- Don’t eat food that impairs gut barrier function
- Eat food that promotes gut barrier health
The first one is pretty easy: avoid refined sugar, refined carbohydrate in general, and lactose if you’re lactose intolerant. For the second and fourth points, make sure to eat fermentable fiber. In one trial, oligofructose supplements led to sustained fat loss, without any other changes in diet (5). This is consistent with experiments in rodents showing improvements in gut bacteria profile, gut barrier health, glucose tolerance and body fat mass with oligofructose supplementation (6, 7, 8).
Oligofructose is similar to inulin, a fiber that occurs naturally in a wide variety of plants. Good sources are jerusalem artichokes, jicama, artichokes, onions, leeks, burdock and chicory root. Certain non-industrial cultures had a high intake of inulin. There are some caveats to inulin, however: inulin and oligofructose can cause gas, and can also exacerbate gastroesophageal reflux disorder (9). So don’t eat a big plate of jerusalem artichokes before that important date.
The colon is packed with symbiotic bacteria, and is the site of most intestinal fermentation. The small intestine contains fewer bacteria, but gut barrier function there is critical as well. The small intestine is where the GI doctor will take a biopsy to look for celiac disease. Celiac disease is a degeneration of the small intestinal lining due to an autoimmune reaction caused by gluten (in wheat, barley and rye). This brings us to one of the most important elements of maintaining gut barrier health: avoiding food sensitivities. Gluten and casein (in dairy protein) are the two most common offenders. Gluten sensitivity is widespread and typically undiagnosed (10).
Eating raw fermented foods such as sauerkraut, kimchi, yogurt and half-sour pickles also helps maintain the integrity of the upper GI tract. I doubt these have any effect on the colon, given the huge number of bacteria already present. Other important factors in gut barrier health are keeping the ratio of omega-6 to omega-3 fats in balance, eating nutrient-dense food, and avoiding the questionable chemical additives in processed food. If triglycerides are important for leptin sensitivity, then avoiding sugar and ensuring a regular source of omega-3 should aid weight loss as well.
Strategies: Micronutrients
As I discussed in the last post, micronutrient deficiency probably plays a role in obesity, both in ways that we understand and ways that we (or I) don’t. Eating a diet that has a high nutrient density and ensuring a good vitamin D status will help any sustainable fat loss strategy. The easiest way to do this is to eliminate industrially processed foods such as white flour, sugar and seed oils. These constitute more than 50% of calories for the average Westerner.
After that, you can further increase your diet’s nutrient density by learning to properly prepare grains and legumes to maximize their nutritional value and digestibility (11, 12; or by avoiding grains and legumes altogether if you wish), selecting organic and/or pasture-raised foods if possible, and eating seafood including seaweed. One of the problems with extremely low-carbohydrate diets is that they may be low in water-soluble micronutrients, although this isn’t necessarily the case.
Strategies: Miscellaneous
In general, exercise isn’t necessarily helpful for fat loss. However, there is one type of exercise that clearly is: high-intensity intermittent training (HIIT). It’s basically a fancy name for sprints. They can be done on a track, on a stationary bicycle, using weight training circuits, or any other way that allows sufficient intensity. The key is to achieve maximal exertion for several brief periods, separated by rest. This type of exercise is not about burning calories through exertion: it’s about increasing hormone sensitivity using an intense, brief stressor (hormesis). Even a ridiculously short period of time spent training HIIT each week can result in significant fat loss, despite no change in diet or calorie intake (13).
Anecdotally, many people have had success using intermittent fasting (IF) for fat loss. There’s some evidence in the scientific literature that IF and related approaches may be helpful (14). There are different approaches to IF, but a common and effective method is to do two complete 24-hour fasts per week. It’s important to note that IF isn’t about restricting calories, it’s about resetting the fat mass setpoint. After a fast, allow yourself to eat quality food until you’re no longer hungry.
Insufficient sleep has been strongly and repeatedly linked to obesity. Whether it’s a cause or consequence of obesity I can’t say for sure, but in any case it’s important for health to sleep until you feel rested. If your sleep quality is poor due to psychological stress, meditating before bedtime may help. I find that meditation has a remarkable effect on my sleep quality. Due to the poor development of oral and nasal structures in industrial nations, many people do not breathe effectively and may suffer from conditions such as sleep apnea that reduce sleep quality. Overweight also contributes to these problems.
I’m sure there are other useful strategies, but that’s all I have for now. If you have something to add, please put it in the comments.
* Since reducing carbohydrate intake wasn’t part of the intervention, this result is observational.
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interesting article. thanks for posting it. it is nice to see there are some people in the sciences that believe obesity is not a moral problem.
another way to lower triglycerides to allow for better leptin sensitivity is vigours exercise. fasting for 24 hours for me is too hard(I suffer from mild hypoglycemia), but my doctor, really nice lady said if you exercise vigoursly which I have been, lowers insulin levels hence lowers triglycerides which are high.also i try to eat lower glycemic carbs and very limit of grains whole grains included.
I started a high fiber supplementation, protein drink in the morning with my low carb breakfast, moderate carb (usually high quality carb only) supper and lower carb rest of the day. with higher fiber additive, oligosaccride and inulin I think that is what it is.
chromium gtf, vitb complex, and heavier vita c (such as lemons, grapefruit, berries in my shake etc)
my goal? lower my insulin resistance, decrease middle of the night hypoglycemia, I don't take insulin, so far my glucose levels are well within normal, the only number indicator of my insulin resistance (besides physical symptoms) is high tryglycerides, I wanted insulin levels checked too but she did not do it for some reason.
I take bp medication, and I am hoping too eventually be able to get off of it.
some of your suggestions are good, tannins are touted as bad but I read others who say it helps fight bad bacteria and fungi (after all it is a plants defense chemical for such things).it also helps with inflammation.so it it protects the plants why not you?
teas are very good for insulin resistance, black tea being the strongest followed by green tea then white tea. I like green tea myself.
RR
Andrea,
I think you'll find that if you do a 16 hour fast starting when you wake up, and not having any substantial calories until late in the day, you'll be surprised that you will not suffer from energy crashes.
The energy crash we're all so familiar with seems to be caused by eating, or even drinking, more than say 10 calories or so, but not by true intermittent fasting. Anecdotally, IF'ers report that they actually feel better while doing a 16 hour fast, with greater clarity and energy.
More than 16 hours can work, too, but you might want to start there to see how it goes.
Please let us know how it works for you!
As always, great post! I have a question about the section on IF, and I really don't know much about fasting. However, is there a way to over come the effects of low blood sugar during fasting, or do you just try to ignore it? The effects I'm talking about are irritability (will people want to be near me or run in fear?), light-headedness, naseau, and just a general obsession with food?
Thanks!
Andrea
Great post the only thing that I didn't agree with is the part where exercise isn't necessarily important for fat loss.
Does not resistance training have a muscle sparing effect? Would this not help to maintain a higher basal metabolic rate therefore leading to increased caloric expenditure?
Totally in agreement with H.I.T.T, its great to see the paradigm shift finally occurring in "cardiovascular" training.
Andy
Any suggestions on oligofructose supplements? I found inulin (FiberChoice at my local grocery store). I've seen products with names like "inulin FOS", but it's not clear to me if they have the shorter oligosaccharides or not. I think I can realistically eat more onions and leeks, but probably not every day – that's why I'm asking about supplements. Thanks.
I simply did not want to eat as much as I usually did. That is definitely not the norm for me.
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Hi EL66K,
I think the kind of studies you mentioned are great, unfortunately they're not prioritized by modern science. There have been some studies in rodents looking at "Western diets" or "cafeteria diets" that are basically a lot of pastries and sweets. They do the same thing to rodent health that they do to humans, minus the heart attacks. Most of them are using normal rodent chow as the comparison group, unfortunately.
Actually, there was a pretty interesting study that Staffan Lindeberg did a while back, now that I think about it. It was the "paleolithic pig" study:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1635051/
Hey, Stephan, you that are in the big leagues, or going there, are you planning to ever do a study like the ol' classic ones? I mean, get a bunch of rats munching on a fine Weston Price like diet and another at SAD (Sattan's approved diet, sad atherogenic doer, sarcastic advent of destruction, etc.) and see which thrive and which get utterly annihilated. Pure gold. I know it sure can be hard to get such a thing recognized, but it would be pure gold. Is there any recent study that does that?
Great synopsis, Stephan.
I hope these kinds of refreshing insights start to become much more widely disseminated. I have good friends who could benefit from hearing these things, but I would be afraid to ever mention them. I know a lovely lady with morbid obesity who might benefit from this, but she has developed such a complex around body image and "fat acceptance" that she may never find out, and I wouldn't dare tell her.
Google Beta User,
I have to agree with Gabriella. As a new mother with a new routine, I'd become bored with cooking and had succumbed to the ease and convenience of too many prepared foods from Trader Joe's (I had fooled myself into thinking TJ's packaged foods were somehow better than the supermarket prepared foods and I had 20 extra pounds to show for it).
In early 2004 when I began eating a low carb diet in earnest (not like when I ate low carb for a few months because of a gestational diabetes diagnosis), I found my interest in preparing good food invigorated and renewed. It really helped that I read up a LOT on low carb diet strategies in general and revamped my cookbook collection to reflect recipe options that were either already low carb our could be easily adjusted. I donated (or in the case of Jane Brody's low fat/high carb cookbook, I tossed it into the trash) many of my old cookbooks because their emphasis on sugar, starch, or grains didn't earn their space on my shelves. I think having cookbooks that took a care of a lot of the calculations was a key factor in my successful transition from a Carb Addict. Non-starchy veggies were increased, and in more varieties.
About 3 years ago I joined a CSA (Community Supported Agriculture) farm subscription program which provided a weekly or biweekly box of fresh produce to play with.
I became far more creative with my cooking and really expanded my horizons into more ethnic cooking styles, more seasonal and local ingredients, and less reliance on 30 minute emergency meal strategies (I often slow roast or BBQ a big roast that can be served in several meals in different ways or frozen for future use).
But it took some and a willingness to think about my food in a new way (and advance planning so I wasn't caught in a food bind – such as making sure I brought something low carb to share at a party so there would be at least one thing I knew I could eat). It was great preparation for going completely gluten-free.
Hi Chris,
Good to know.
Hi Prag,
I wouldn't worry about the tannins in moderate quantities of tea, coffee and wine. We're built to tolerate a certain amount of them.
Stephan,
Do you think tannins should be avoid then, or used in moderation, especially in the aforementioned (coffee, tea, cocoa) substances?
I drink one of those three (without caffeine or sugar) almost every day.
I also love wine and smoked meats.
Stephan Re your last comment – Here is a related study. I know it is in Diabetics but the point seems to be that replacing carbs with either fat or protein is the benefit.
http://www.ncbi.nlm.nih.gov/pubmed/20113388?dopt=Abstract
Hi Ed,
I don't really know. I do think protein is satiating, but whether eating high protein leads to weight loss in the long term I'm not sure. I think there's some data to that effect. But what is the protein replacing? Typically carbohydrate.
Hi Rainer,
I know of Dr. Dahlqvist because she links to my posts periodically, but unfortunately I don't know much about her approach because I can't read it!
Hi Jack,
That's a cool study. ROS aren't all bad!
Hi J.A. Deep,
My post really is about fat loss. There is a connection between overweight and the diseases of civilization, but it's complex and I'm still trying to understand it.
Hi Ed,
I don't really know. I do think protein is satiating, but whether eating high protein leads to weight loss in the long term I'm not sure. I think there's some data to that effect. But what is the protein replacing? Typically carbohydrate.
Hi Rainer,
I know of Dr. Dahlqvist because she links to my posts periodically, but unfortunately I don't know much about her approach because I can't read it!
Hi Jack,
That's a cool study. ROS aren't all bad!
Hi J.A. Deep,
My post really is about fat loss. There is a connection between overweight and the diseases of civilization, but it's complex and I'm still trying to understand it.
Hi Glenn,
Thanks! I wonder about vitamin D. There was a clinical trial showing that it doesn't cause fat loss on average. But maybe certain people respond to it.
Hi David,
Good point about the tannins. I think disrupting digestion is their job.
Hi Bill,
That's great, I hope you continue to make progress.
Hi Sam,
By moderate LC, I'm talking about roughly 25-40% carb. Yes, that precludes ketosis.
Hi J.A. Deep,
I don't know, maybe I'll write a book someday. I'm not ready yet.
Google Beta User,
It's ironic that not consuming rice, bread and other grains results equates to dietary boredom. The foods you mention are the ones with the least amount of flavour.
I've had people express the opinon that low carb/no bread must be boring. So I ask them if eating bread for breakfast, lunch and supper isn't even more boring and if not, why not.
I don't think it's possible to become addicted to meat or fish but it's sure easy to get addicted to grains and sugar.
It takes a while before not making toast for breakfast is totally normal and there is no desire to eat grains for breakfast.
Which reminds me, I've got to put the toaster away. It's taking up valuable counter space.
About heart disease and supplements, never forget Q10!
I am going to remove butter from my diet because since weeks after begining to take it I have developed a strange chest pain I have never had. I will mantain a very small amount of coconut oil. I will go to my cardiologist but I feel more comfortable obtaining K2 and D3 from supplements and Omega3-eggs.
Regarding magnesium supplementation, there is a nice do-it-yourself alternative — mag water — that I have used for months, and find simple, cheap and without side effects. The following is a post (not by me) from http://www.mgwater.com/email02.shtml. Dr. William Davis, a solid and trustworthy guy, asserts that mag-water is well absorbed and recommends it.
Date: Sat, 7 Sep 2002 19:32:56 EDT
HOMEMADE Mg-BICARBONATE WATER
For some time I've been drinking a Mg-bicarbonate water that I make very inexpensively from Milk of Magnesia (magnesium hydroxide) and seltzer water (CO2 water). It has (by math) ~84 mg Mg and ~422 mg bicarbonate per liter and tastes great. The downside is that this water has no other minerals, but I do take a multi-mineral tablet. Here's the recipe:
The equation Mg(OH)2 + (CO2)2 = Mg(HCO3)2 is interesting, because Mg(OH)2 is magnesium hydroxide, as in milk of magnesia (MoM), and CO2 is the fizz in carbonated (seltzer) water. Combining them produces Mg(HCO3)2 (magnesium-bicarbonate), as in … and Adobe Springs ("Noah's") water. Be sure to get the MoM in which the "active ingredient" is Magnesium-hydroxide and nothing else, and the "inactive ingredient" is purified water and nothing else. You'll see on the label that one teaspoon of MoM = 400 mg of Mg-hydroxide. 42 % of Mg-hydroxide is Mg, which equals 168 mg of Mg per teaspoon. Chill for an hour or two in the refrigerator a 1 liter bottle of seltzer water (not soda water), which consists of water and CO2 only. Open it, and when the fizzing settles down, spoon in 2 tablespoons (6 teaspoons) of milk of magnesia, put the cap back on, shake gently every few minutes and watch the cloudiness disappear as the Mg-hydroxide reacts with the CO2 and becomes Mg-bicarbonate. This 1 liter (approximately 1 quart) will have ~1,008 mg of magnesium + ~5,061 mg of bicarbonate.
Summary: 1 liter seltzer water + 2 tablespoons (6 teaspoons) milk of magnesia = ~1,008 mg of magnesium + ~5,061 mg of bicarbonate per liter (~ 1 quart). You should dilute this, 1 part Mg bicarbonate water with 11 parts regular water, so 1 liter of the concentrated will yield 12 liters (about 3 gallons) of drinkable water with ~84 mg Mg and ~422 mg bicarbonate per liter, close to Adobe Springs water, below, for Mg and bicarbonate, and probably for pH also: Adobe Springs ("Noah's") magnesium and bicarbonate rich spring water is from some mountains in California – see adobe.shtml Adobe Springs water has 120 mg Mg and 410 mg bicarbonate per liter, with a pH of 8.3, according to their web-site.
. . .
2 tablespoons (6 teaspoons) of MoM per one liter of seltzer water seems to be the correct amount- it all reacted with all of the CO2 (no MoM residue and no apparent fizzing, even when shaking the bottle). My cost is $ 0.81 per gallon using reverse osmosis water from the machine at the local market @ 39 cents per gallon. Using tap water it would be 42 cents per gallon. Cheap!
My cost: MoM, $4.29 for 71 tsp = $ 0.36 for 6 tsp.
Seltzer water —————-$ 0.89 for 1 liter
* * *
The taste of this is not that great, but if you make it a little less potent — 1.75 tablespoons to the quart, it is palatable. I make it full strength and add just a tad of OJ to it. I drink 8 to 12 oz a day to get my intake (combined with dietary sources)well North of the 420mg or thereabouts that is the recommended daily allowance level for men over 30.
Does one derive moderate benefits from "moderate cardio" as opposed to low cardio if one is disciplined?
I'm on week 4 of Paleo. The weight loss is good. I'm not a health noob, so I do try to take care of myself.
However, so far, the lack of variety from a strict PAleo is driving me nuts. Boredom.
If one allows themselves to eat some carbs (sweet potatoes, rice, whole bread, etc) for example every other day does 1. It still cause insulin spikes? and 2. Will it cause a rapid weight gain and 3Will it cause the hunger cravings to return? and 4. Will problems arrive once I hit my 40s?
This post along with Richards interesting post on his Paleo problems (over on freetheanimal)is why I'm asking these questions.
Regards,
Ooops, forgot to check off Email follow-up option
Hi Stephan:
The body has a mechanism for regulating vitamin D whereby, once you've made enough from the sun, any extra vitamin D made by your skin, will be degraded to avoid overdose. Does this system also take into account vitamin D consumed. So that if you take the recommended 1000 IU per day per 25 lb of body weight, year round, you will make slightly less vitamin D from the sun than if you didn't supplement at all?
Stephan, I very much appreciate the thoughtful and kind tone of your post. May I be so bold to ask, is your post meant to be only about weight loss?
Or are you hinting at a new view, in which weight, as described by fat mass setpoint, is correlated with many other so-called illnesses. In this new view, espoused I believe now by Taubes and others, the very idea of what illness is — is transformed, so that a single metabolic marker of fat mass setpoint predicts whether a person is healthy or not? As the fat mass setpoint goes up or down, the likeliness of a spectrum of illness, whether diagnosed or not, goes with it.
I wonder if this may be implicit in how you begin, "many health conditions can be improved, and in some cases reversed, through lifestyle interventions"? Sorry if I've wrongly presumed.
ItsTheWooo,
The interesting part about darker days is that some of us gain weight without changing our diets or getting hungrier – which leads me to the conclusion that eithar a) one eats just slightly more, or b) the body stores more of what you eat.
I would have understood the gain if I had a raving hunger 24/7, but that is not the case.
Chromium GTF has made a huge difference for me.
Inositol is another great vitamin. I suggest you research it. It is possibly more effective than chromium, at least for me.
Bright light therapy is also useful for both mood and metabolism. People get fat in the late fall/winter for a reason.