The miracle cure for losing weight is knowing that there is no miracle cure. There is no herbal pill, no surgical procedure, no acupuncture protocol that can accomplish this. The only cure is diet and exercise, and in many cases diet is enough: caloric reduction.
Obesity is the major health concern of our generation, and to ignore it is to ignore our greatest opportunity for creating health, vitality and longevity. Speaking directly to patients about the need for weight control requires our initiative. Patients who are overweight want to lose weight, and have probably tried a variety of approaches, but are reluctant to broach the subject.
To tackle obesity in our patients, the best starting place is understanding human physiology in relationship to our evolutionary development. Our hominid ancestors date back 7 million years. Lucy, the famous Australopithecus, lived 3.2 million years ago, and since then, for the next several million years, at least 14 hominid species developed in Africa, sometimes co-existing, often arriving and then dying out. These ancestors were bipedal foragers, eating fruits, nuts, roots, and wild game. They migrated out of Africa numerous times. 500,000 years ago, Homo heidelbergensis, the common ancestor to both Neanderthals and Homo sapiens, existed in what is now Europe and Central Asia. The fossil record confirms all of this, and also tells us that our species, Homo sapiens, has existed at least 200,000 years.
What has this to do with the modern obesity epidemic? Understanding how we developed, what we ate, what we evolved to eat - all of this has developed over millions of years. We have the bodies of hunter-gatherers. We ate when we could, and we gorged ourselves on food when we could, without knowing for certain if the next meal would be tomorrow or next week.
We evolved to store excess as fat, to be used in times of need. Every cell in our body needs glucose to produce ATP, and we need it every minute, every hour, every day of our lives. The body can reduce almost every food group to glucose: complex carbohydrates found in vegetables, fruit and roots; fats from animals, even animal protein. All of this can be converted into glucose. The cells will only take in what it needs, and the rest will circulate in the blood or store in the liver until it can be used. If we are so lucky to have more than we can hold in our blood and liver, we will store it first as triglycerides in the blood, and then as as fat stored in various tissues. The body keeps these reserves in storage until it senses that it is starving, at which time it will release fats to be used as an energy source for ATP production.
The key phrase here is, "until it senses that it is starving." Fats will release out of storage only when it realizes that available stores in the liver and blood are depleted, and new intake of dietary glucose is not forthcoming. At that point, a chemical switch turns on, prompting cells and tissue that are storing fat to let it go. Once dietary glucose becomes available again, that switch turns off, so it is necessary to starve the body until the fat reserves are down to the desired level. Starvation happens slowly, and for 5 to 7 days, the body will not release its reservoirs. Instead, it says it is hungry, and tells the owner to find food. This fact allows our big trick. Starve the body by providing no source of glucose, and the fat will release to the tune of 12 pounds per month.
How do we starve the body? By avoiding the five whites: grains, dairy, sugar, potatoes and rice. - the five whites. Keep it simple. What does this include? Breads, pasta, cookies, cakes, pastries, cheese, yogurt, milk, ice cream and all desserts. Potatoes, rice, corn and all grains. What do we eat? Paleo, the diet of our ancestors: meats, fish, eggs; any and all vegetables and fruits; some nuts, beans in moderation. Within these confines, you can eat as much food as you want. Snack on fruits, carrots, and celery. Even though these are "high glycemic" it's not enough to turn the switch off. Watch the pounds melt away.
The Paleo diet need not be a lifelong diet; just one that reduces weight by ketosis, burning stored fat. Have a target weight (with a BMI of less than 25) and when you reach that weight, you can start adding in foods: starting with rice, then potatoes or bread. Maybe yogurt. But use a scale. If you gain a pound, ask yourself, what did I eat yesterday that added weight? Avoid that food for a while, until the ideal weight is again achieved.
Is Paleo the ideal diet for life? Maybe, maybe not. For people with any blood sugar regulation issues, it is an ideal diet – minimum glucose intake. But the Dean Ornish diet is also good: low fat, low sodium, high vegetable diet, and probably a better diet for modern times. Paleo diet worked great when our human ancestors numbered in the millions, not the billions. Now, as a planet with 7 billion people and growing, a high animal diet is no longer sustainable. Vegetarian diets make much more sense. But as a weight loss program, Paleo is quick and healthy, based on our evolutionary physiology.
Face-to-face with Obesity
We need to talk to our patients about obesity, literally the elephant in the room. I had a patient who came in with knee problems. Her mother had died at age 57 of heart failure, and my patient was now 57. She was 5'4", and weighed 280 pounds. On our first visit, after taking her history and listening to her concerns, I said, "We can put needles in your knees every day for weeks, and it will not solve your knee problem. Your knees cannot support 280 pounds. But more important, your heart can't support 280 pounds! Do you want to end up like your mother, who died at the same age you are now?" She looked at me and said that I was the first doctor who ever told her this, who ever was willing to address the weight issue. Unhappily, I believe her.
"How do I lose weight?" she asked. I told her that I wasn't a weight clinic, that it would be best to get into Weight Watchers or Jenny Craig or some weight loss program where you were monitored every week. But, I said; if you want to lose weight, do Paleo. No grains, dairy, sugar, rice or potatoes until you lose your weight. She looked at me and said, "Well, I can't do that. I can't give up bread and cheese!" I gave her this look that said, "It's your life. It's your decision."
I didn't see her again until eight months later. She told me she lost 100 pounds. I was amazed. "Was it Weight Watchers? What program did you do?" She replied, "I did your program. I did what you said." This was a great moment.
Reasons for the Obesity Epidemic
There are six factors that contribute to the obesity epidemic careening out of control in the United States.
Americans overeat. We eat way too much. We stuff ourselves. Americans like to snack – we snack in the car, we snack watching television, we are constantly grazing, and then we consume jumbo portions at a restaurant.
Americans eat the wrong foods. We like our food to be convenient, and we end up eating packaged foods, basically baked grains, sugars, and snacks. We eat excessive amounts of dairy and sweets. Things like mac and cheese, pizza, hamburgers, soda pop, beer, cookies, candy, cakes, ice cream. We only need 1,600 to 2,200 calories a day, depending on our size and exercise level. What happens when our patient goes to McDonald's? A Big Mac is 550 calories, large fries another 500 calories, and a large Coke with 300. Do you want cookies or a pie with that?
We do not know how to cook. Something occurred after the 1960s where Americans were taught that it is servile or demeaning to cook for others, and the art has been lost. We do not know how to buy simple ingredients and make a meal. This has only become worse with college-aged kids, who have not been taught by parents who don't know how to cook anyway. Not cooking means we go out to restaurants, order take-out, or buy packaged foods. These foods contain excessive sodium, sugar and carbohydrates.
Cold foods and snacking have destroyed our stomach fire. Usually, stomach fire is affected as mingmen fire diminishes, something that happens in older age. This segment of the population, historically, would lose their digestive fire, and with that, their appetite. Nowadays, younger people eat from the fridge: orange juice, yogurt, iced drinks. All this damages our stomach fire, and we cannot digest food or absorb its nutrients. Starving, we are hungry all of the time. And constant snacking keeps insulin elevated, also promoting hunger.
Two cultures that manage to stay thin are China and France. China traditionally had three hot meals per day and France, 2 hot meals per day. And no snacking!
High fructose corn syrup has injured us. Overweight is defined as a BMI (body mass index) of 25 to 30. This rate has remained relatively constant between 1960 and now. However, obesity rates (a BMI over 30) have skyrocketed, shooting from 16% in 1980, to 34% in 2008. What happened in 1980? This is when high fructose corn syrup was introduced into packaged foods and drinks, and when corn, instead of grass, became the main feed for meat cattle. High fructose corn syrup becomes fat much more readily than even sugar.
Bovine Growth Hormone added to meat and dairy. Not only does it turn a 600 lb cow into a 1,300 pound cow in 6 weeks or so, it also contributes to the high rate of breast and other cancers.
Getting your patients to lose weight may be the single most important thing you ever do for their health. This can be accomplished by exercise, but it would take 60 minutes of daily sweating to accomplish this. Once weight is down to "normal" (a BMI less than 25), exercise can burn the extra calories one wishes to take in. But for getting down to that weight, you must first deny them the five white glucose sources! Think Paleo diet.