Do I care that the obesity rates in America are soaring? Does it bother me that we went from 12% of Americans being obese in 1990, to 35.7% in 2010, or that 69% of ALL Americans are now considered overweight? Not really. If people want to be fat, then be fat, but what bothers me is when I can’t lose the last ten pounds no matter what I try, or that my husband’s weight, along with his blood pressure, keeps creeping up and up and up year after year.
For the first part of our marriage, we thought we were doing the “right thing” by following the government recommend dietary guidelines of a low-fat, high carbohydrate diet, but then I started learning the truth about fats and about how we were duped into thinking saturated fat and cholesterol were bad in the first place, and in his book, Why We Get Fat, Gary Taubes completes the picture for me by thoroughly explaining how it’s not fat that’s making us fat, it’s carbohydrates. He explains that it’s not as simple as “calories in, calories out” and that it doesn’t matter how many calories we consume, but what kind.
“Not all of us get fat when we eat carbohydrates, but for those of us who do get fat, carbohydrates are to blame; the fewer carbohydrates we eat, the leaner we will be” (p.134).
So WHY DO carbohydrates make us fat, and why does eating a carbohydrate rich diet make us overeat and gain weight? In a nutshell, the answer lies with the hormone insulin. Insulin is secreted to help the body metabolize glucose that comes from the breakdown of all carbohydrates. The longer our insulin levels are raised, the less time we spend burning stored fat. If we want to lose weight and access some of the fat we’ve been storing, we HAVE to lower our insulin.
The problem is that over time, for a variety of reasons, we become insulin resistant. To be more specific, our cells become insulin resistant as they protect themselves from an onslaught of glucose. When this happens, insulin is coursing through our veins even when we haven’t eaten anything or worse, when we have eaten, but none of the glucose can get into the cells and so we STARVE at the cellular level. This makes us hungry and we keeping eating and eating and eating, but we aren’t getting satisfied.
And thus begins a vicious cycle where we’re not getting fat because we’re eating too much, but we’re eating too much because we’re getting fat.
Here is a great look at how insulin makes us store fat. This diabetic man injected himself with insulin in the same spots on his lower abdomen for more than 30 years. As a result he got lipohypertrophy, which isn’t the result of “eating too much” but rather the insulin doing it’s job of storing fat in a central and localized area.
Are you curious to know how insulin works to make us fat? Read on to get a thorough understanding of the role insulin plays in our digestion.
1. The pancreas begins secreting insulin when we simply think about eating carbohydrates. We may not have been really hungry before, but once we start to think about eating a freshly glazed doughnut or a big plate of spaghettu, we realize that we are suddenly STARVING. The insulin is doing it’s job; it’s preparing our body for what we are about to eat.
2. As it is digested, all food can basically be broken down into three categories: glucose (from carbohydrates), fatty acids (from fat), and amino acids (from protein). The only thing that stimulates insulin production is glucose, but any fat or protein that comes into the body with the glucose, will be stored as fat and dealt with later because the glucose is much easier to metabolize and so it is taken care of first.
- Carbohydrates are digested easily for quick energy. Enzymes from our saliva, pancreas, and small intestine work to break the carbohydrates down into glucose. Whatever isn’t needed for immediate energy is repackaged into larger bundles called glycogen and stored in the liver or muscles. The liver releases small amounts of glycogen over the next 8-12 hours as energy is needed. If there is still excess glucose after maxing out glycogen storage, it will be converted and stored as body fat.
- When we talk about fats, there are two distinct kinds. First we have Long-chain fatty acids found in polyunsaturated fats like canola oil and monounsaturated fats like olive oil and avocados that take a long time to be metabolized. In order to metabolize these fats, they must be digested with bile acids from the liver and enzymes from the pancreas called lipases before they can be sent into the bloodstream. When you eat long-chain fatty acids with any carbohydrates, they will be immediately stored as fats, and if you are insulin resistant (which I’ll address later) or continue to consume carbohydrates, they will not be released from the fat cells. Then we have Short- and medium-chain fatty acids found in saturated fats like coconut oil and butter that are digested easily and can be used for quick energy. They break down without any help from bile acids and are sent directly to the liver where they are metabolized for quick energy. If you were to eat short- or medium-chain fatty acids by themselves, it is virtually impossible for them to be stored as fat. When eaten with carbohydrates, say on a piece of bread and butter or in raw cookie dough, this becomes a bit of a gray area and depends on
- When protein is digested into amino acids, these building blocks are used to build and repair tissue. They can be used as energy if there’s no other source of energy. If eaten with carbohydrates, they will not be stored as fat.
3. So as ANY carbohydrates enter the bloodstream and are converted to glucose, insulin is secreted and starts doing its job. Now there are only two things that bring blood sugar down: one is physical activity that will drive sugar from the blood into the muscles where it will be burned as fuel and the other is insulin. When insulin is released into the bloodstream, it is like a traffic cop directing glucose to the cells to be used as energy, to the liver or muscles to be stored as glycogen, and once the glycogen stores are full, to the fat cells to be stored as fat.
4. While insulin is busy shuttling glucose around, it is also stimulating the lipoprotein lipase (LPL) enzyme that pulls fat from the bloodstream into the fat cells. Insulin just wants us to survive. When there is a lot of glucose coming in, it is like a squirrel storing away nuts for the winter, and it tries to store away whatever glucose isn’t immediately being needed elsewhere. When insulin is present, more LPL enzymes are stimulated to pull fat into the fat cells.
5. At the same time, insulin is also suppressing the hormone sensitive lipase (HSL) enzyme which is responsible for making fat leave the fat cells. When there are individual fatty acids in the bloodstream, they are small enough to pass back and forth through the cell membrane. But once a glycerol molecule binds together with three fatty acids, it forms a triglyceride, and a triglyceride is too big to leave the fat cell. The only way a triglyceride can be broken down is with the help of HSL. When insulin is present, it prevents the HSL from breaking apart the triglyceride and thus the fat remains trapped inside the fat cell, and we are unable to use it as fuel.
6. Once our blood sugar levels begin to decrease, the insulin levels will also decrease (in a normal functioning metabolism). When this happens, any fat that was ingested with the carbohydrates can now be burned as fuel.
7. If insulin levels don’t decrease however (because the body is becoming resistant to insulin), then the fat that was eaten with the carbohydrates cannot be unlocked for use as fuel, and so we get hungry again before we’ve even burned all of the calories we’ve consumed. So what leads to insulin resistance?
- Insulin resistance starts in the womb. As the pancreas of the child develops, it must secrete more insulin if the mother has high blood sugar. When it is born, it will have a tendency to over secrete insulin, become insulin resistant, and then become fat as it gets older. Gary Taubes points out that, “in animal studies, this predisposition often manifests itself only when the animal reaches its version of middle age” (p. 132).
- The bottom line is that too much glucose over a long period of time is too much for our bodies to handle. Too much sugar is toxic not only to the blood, but to the cells as well. In his article on the Weston A. Price Foundation website, “Treating Diabetes: Practical Advice for Combatting a Modern Epidemic“, Tomas Cowan, MD, explains that, “The cells build a shield or wall around themselves to slow down this influx of excess sugar. Insulin resistance is a protective or adaptive response, it is the best the body can do to protect the cells from too much glucose.” When insulin remains elevated, the fat in the bloodstream, the fat stored in the fat cells, the protein stored in the muscle cells, and the carbohydrates stored as glycogen in the liver and muscle tissue cannot be used as fuel. As a result, the cells find themselves starved for fuel and we get hungry…starving in fact. Either we eat sooner than we otherwise would have or we eat more when we do. Meanwhile, our bodies are getting bigger because we’re putting on more fat, and we’re also building more muscle to support that fat. Gary Taubes explains that, “As we fatten, our energy demand increases, and our appetite will increase for this reason as well – particularly our appetite for carbohydrates, because this is the only nutrient our cells burn for fuel when insulin is elevated” (p. 126). And thus, we’re not getting fatter because we’re eating more, we’re eating more because we’re getting fatter.
- Just getting older makes us more insulin resistant. As we age, we secrete more insulin, which results in more calories being diverted to fat and fewer calories being left to fuel the body. This leaves the cells to generate less energy. So we’re not getting fat because our metabolisms are slowing down, our metabolisms are slowing down because we’re getting fat. As we become insulin resistant, a whole host of other problems start to arise: our blood pressure goes up, our triglyceride levels go up, our HDL cholesterol goes down, and so on. Tomas Cowan, MD, explains that, “Having a chronically elevated insulin level is detrimental for many other reasons. Not only do high insulin levels cause obesity (insulin tells your body to store fat), but they also signal that fluid should be retained, leading to edema and hypertension. Chronic high insulin provokes plaque development inside the arteries and also suppresses growth hormone needed for the regeneration of the tissues and many other physiological responses.”
8. When either the pancreas can’t make enough insulin to deal with the incoming sugar or the cells have become resistant to the insulin over a long period of time, it can lead to diabetes. 25.8 million people in America have diabetes. That’s 8.3% of the population. Complications from diabetes can lead to heart disease and stroke, high blood pressure, blindness, kidney disease, nervous system disease, and amputation. Gary Taubes explains how diseases such as obesity, diabetes, heart disease, hypertension and stroke, cancer, Alzheimer’s, cavities, appendicitis, ulcers, gallstones, hemorrhoids, varicose veins, and constipation are common in societies that eat Western diets and are virtually nonexistent in societies that don’t. But it’s not ALL aspects of a western diet, as mainstream nutritionists and public health officials would have us believe, that lead to these maladies. It’s the sugar, carbohydrates, and how our body reacts to insulin.
- “Treating Diabetes: Practical Advice for Combatting a Modern Epidemic“, Tomas Cowan, MD “Unless eaten to great excess, fats do not contribute to diabetes–with one exception. Trans fatty acids in partially hydrogenated vegetable oils can cause insulin resistance. When these man-made fats get built into the cell membrane, they interfere with the insulin receptors. In theory, this means that one could develop insulin resistance without eating lots of carbohydrates. But in practice, partially hydrogenated vegetable oils are always used in the very high-carbohydrate foods–french fries, cookies, crackers, donuts and margarine on bread or potatoes–that flood the bloodstream with sugar. Trans fatty acids in modern processed foods present a double whammy for which the human species has developed no defenses.”
- “During the 1980s, researchers began to ask whether obesity, coronary artery disease, hypertension and other common medical problems that occur together are really separate diseases, or manifestations of one common physiological defect. The evidence now points to one defect and that is hyperinsulinemia, or excessive insulin levels in the blood. Hyperinsulinemia is the physiological event that links virtually all of our degenerative diseases. It is the biochemical corollary or marker of the events described in heart disease.”
So now that we know what makes us fat (insulin), what can we do about it? In this scenario, I envision that there are three types of people in the world:
- People who want to lose weight (either a lot of weight or a little weight)
- People who don’t want to lose weight (either because they just don’t want to or they’re not fat)
- People who are growing (children, pregnant and lactating women, and people who need to gain weight)
For the people who want to lose weight, here is what Gary Taubes suggests that you do.
1. The first thing to understand is why the “calories in, calories out” theory is wrong. When we see ourselves putting on a little weight, there’s a little voice in our heads that tries to to motivate us throughout the day, “Just stop eating so much!” it says. But it’s not that simple.
- Gary Taubes talks about a group of women who tried to do just that. In 1990, the National Institute of Health conducted a study that they hoped would answer whether low fat diets prevented heart disease or cancer. So they spent one billion dollars and had 20,000 women eat a low-fat diet rich in fruits, vegetables, and fiber. These women also cut their caloric intake by about 360 calories per day. After eight years, they lost an average of two pounds each and their waist circumference increased, meaning that the weight they lost was lean muscle. Also, they still got just as much cancer and heart disease.
- We could cut calories to the point of starvation to try to lose weight, but our bodies would just adapt in other ways. Our body temperatures would decrease, we would expend less energy, we would be cranky, irritable, and not to mention STARVING, and then the only way we could maintain this weight loss would be to maintain a lifetime of starvation. Does that seem possible? I didn’t think so. So if cutting calories doesn’t make us lose weight, increasing calories shouldn’t make us gain weight.
- That’s because it’s not about how many calories we eat, but what kind of calories we eat. Thinking that a person gets overweight because they can’t control their eating or that they should just be better at portion control is just plain wrong. Saying that a person gaining weight is a result of their immoral gluttony is like saying an alcoholic becomes dependent on alcohol because of the sinful act of drinking. It’s kind of like, well duh! But the real questions should be: WHY do some people overeat? WHY do some people store all of their incoming calories as fat? WHY so some people drink to excess? and WHY do some people become addicted to the altered state that alcohol brings? These questions will get us to the real root cause of the problem. If it were as simple as “calories in, calories out”, then the very act of eating one extra slice of bread over the course of twenty years would make us gain an extra fifty pounds, and conversely, we should be able to lose that extra fifty pounds by eliminating the equivalent of one slice of bread to see the pounds gradually waste away. But it doesn’t work like that.
- Also, it’s helpful to think about growing children in this scenario. Children do not grow because they are eating too much; they start to eat more because they are growing. If you were to restrict a child’s calories, they would still grow, their growth would just come at a cost to their internal organs, brain functions, and growth quality. Children grow because of hormones. The hormones are telling their bodies where and how to grow. It is the same with adults. Male hormones tell a man to gain weight in his abdomen, female hormones tell a woman to gain weight in her hips, butt, and thighs, and the hormone insulin, stimulated by the overabundance of glucose, tells our body to store fat.
2. If you don’t want your body to store fat, then don’t eat sugar. It’s as simple as that. Sugar stimulates the “reward center” of the brain in the same way that heroin, cocaine, nicotine, alcohol, and other addictive substances will. All food does this to some degree, but sugar seems to hijack the signal to an unnatural degree by flooding the neurotransmitters with an unparalleled amount of dopamine. You can quit eating sugar, but it will take the same vigilance as a drug addict trying to kick his or her drug habit. (Actually, according to a new study, sugar is more addictive than cocaine.) When trying to decide between eliminating carbohydrates completely or simply limiting them, Gary Taubes explains, “If you continue to eat some of the fattening carbohydrates or allow yourself some sugar (or even, artificial sweeteners), though, you may always have the cravings” (p. ). When I was trying to quit drinking, I personally found it much easier to get rid of drinking all together, rather than trying to learn how to “drink in moderation” as I describe in my blog: Dealing with Addiction. I personally believe that having a few sweet treats (like homemade cookie dough with real butter, pastured eggs, and dark chocolate chips) is just fine every once in awhile, but only if you’re at your ideal weight.
3. What about high fructose corn syrup? High fructose corn syrup is made up of about 55% fructose and 42% glucose. So when the glucose enters the bloodstream, it raises blood sugar, and stimulates insulin. The fructose, however, is metabolized almost exclusively in the liver. When the liver is flooded with that much fructose, it turns most of it into fat. Because insulin levels are raised from the glucose, the fat is immediately shuttled into fat cells. The more high fructose corn syrup we consume and the longer we do so creates a pattern that our bodies adapt to by converting the fructose directly to fat. Over time, this also creates a fatty liver and causes muscle tissue to become resistant to insulin. A very fascinating point made by Gary Taubes states that, “It’s quite possible that if we never ate these sugars we might never become fat or diabetic, even if the bulk of our diet were still starchy carbohydrate and flour” (p. 138). He explains further that this could be why some of the world’s poorest populations live on carbohydrate rich diets and don’t get fat or diabetic. I believe that two of the biggest culprits here are sodas and breakfast cereals. Eliminate these right away!
4. Next, cut out all carbohydrates (or greatly reduce them), and replace them with fats. And not just any fats…saturated fats. (Read The Truth About Fats, How We Were Duped Into Thinking Saturated Fat and Cholesterol Are Bad, Benefits of Butter, and Choosing the Right Oil to learn more about eating the right kind of fats.) As we do this, we’re creating a radical shift in the fuel our cells will burn for energy. When we consume less than sixty or so grams of carbohydrates a day (a slice of pizza has 40 grams), our body will enter what is called a state of ketosis. Now instead of running primarily on carbohydrates, our body (and brain) must get used to running on fats…including the fat that has been stored in our body. The side effects of this transition could include weakness, fatigue, nausea, dehydration, diarrhea, constipation, dizziness, and light-headedness. But these carbohydrate withdrawal symptoms are short lived and are far outweighed by the benefits of living a longer, leaner, and healthier life. (Read my blog, From Candida to Thrush to learn how cutting out carbs and sugar can help you get rid of both.)
5. What about hypoglycemia? Neither hyperglycemia (high blood sugar) or hypoglycemia (low blood sugar) is good. When blood sugar dips too low, you can become disoriented, confused, shaky, jittery, anxious, and irritable, and if the situation persists, you can slip into a coma and die. The body reacts to low blood sugar by producing adrenaline and releasing the carbohydrates we’ve stored as fat called glucogen. As a person recovers from hypoglycemia, he or she may need to be very careful by gradually reducing carbohydrates to a safe level.
6. What about protein? One point of caution with this “Atkin’s diet” mentality is trying to eat too much protein without the accompanying fat. By keeping protein to 20-25% of the diet, symptoms like weakness, nausea, and diarrhea can be avoided. So eat the egg whites with the yolk, don’t drain the fat after browning meat, and cook your food in loads of butter and coconut oil.
7. What about vegetables? Vegetables are broken down into carbohydrates. It takes much longer for them to be digested because they contain more water and fewer digestible carbohydrates for their weight than starches like potatoes. As a result, they will have a minimal effect on blood sugar. But this effect, however small it might be, could still be a problem for some people with severe insulin resistance or diabetes.
8. What about fruit? Gary Taubes explains that, “If we’re predisposed to put on fat, it’s a good bet that fruit will make the problem worse, not better” (p. 136).
9. But if I don’t eat any carbohydrates, won’t I get constipated? Gary Taubes states that, “It is a misconception that carbohydrate-restricted diets cause constipation” (p. 222). By adding sodium back into the diet (I advice Real Salt or bone broth), he explains that this problem can be easily handled. If not, I recommend getting some psyllium husk.
10. Fasting for 18-24 hours might work to break through plateaus of weight loss, but achieving weight loss through semi-starvation can only be maintained if the dieter can keep eating less and less food. When the body is in semi-starvation mode, the fat cells will be working hard to recoup the fat they’re losing.
In conclusion, making a major change in diet after eating the same way for a really long time can create some radical changes in the body and being able to talk to a doctor or nutritionist during this transition is advised, but Gary Taubes points out that, “physicians who tell their fat patients to eat less and exercise more, and particularly to eat the kind of low-fat, high carbohydrate diet that the authorities recommend, will not be sued for malpractice should any of those patients have a heart attack two weeks or even two months later” (p. 216). It would be nice if doctors REALLY had our best interests in mind when “guiding us”, but they are compelled to repeat the same mantra that has misled our nation into rampant obesity, heart disease, and cancer. When it comes to the nutrition for me and my family, I prefer to be an advocate for our own health, do my own research, and whenever possible let FOOD be our medicine.
- Treating Diabetes: Practical Advice for Combatting a Modern Epidemic by Thomas Cowan, MD
- Why We Get Fat by Gary Taubes