“over the past decade, everything has changed…”
This is a blog dedicated to weight health and to the discussion of satiety as the guiding light and principal most likely to result in success for most individuals.
“Satiety” (sa-TY-i-tee) – as I will use it here, is the sense of having satisfied one’s appetite for food; one’s appetite has been satisfied by the food consumed.
“Weight Health” – refers to the fact that there is a lot more involved in a person’s health and well-being than simply how much body fat they may be carrying. The amount of body fat must not be such a dominant concern that other aspects of health and well-being are neglected, discounted or put in jeopardy. A better term would be “body composition health” since it is now understood that many of the people who are slim or have a body weight in the “normal” range are suffering harm from relatively small amounts of body fat, but tucked hidden within their bellies.
Because over the past decade everything has changed. Excitement and hope are the realistic, practical outcome.
We used to think we knew what we were doing when it came to weight (fat) loss. If only people could be disciplined and follow the medical advice, all would be solved. Just eat less and move more. Go hungry, if need be. Even if you get very hungry, tough it out and above all “don’t break your diet”. “Diet” always referred to a limit on the total calories consumed in a day. (The limit being a calorie number given or being a set limit on total food servings, which is just a less obvious way of setting a calorie limit.)
There is a growing chorus of voices suggesting/demanding a total re-thinking of the approach to weight control, from the basic concepts on up.
Calorie-restricted dieting has not saved us. For the population as a whole, the message has not stopped a growing crisis of obesity. For people who are individually prescribed such diets as part of their medical care, the long-term results are stunningly disappointing. This reality is now just so obvious to everyone that it cannot be ignored or brushed aside any longer. Yes, some people do well and we need to learn from them, but over-all we are getting further behind.
Calorie-restricted dieting may have unexpectedly and quietly caused long-term harm. There is a growing movement of rejection of calorie-restricted dieting for various reasons, suggesting that this practice might increase the risk of dis-ordered eating patterns, eating disorders, food addiction, depression, lowered metabolism, etc. There is an urgent need for research to answer these concerns.
The past decade has brought us new information and understandings that profoundly change our options and demand a re-working of our concepts.
Obesity itself is not as much of a major cause of death or illness as we have been thinking. The amount of body fat is generally not the major factor in obesity-associated death and illness, other than at very high levels of body fat. Some people can be quite obese and not have much health impact (excluding effects related to physical size, such as stress on joints.) The type of medical harms that we usually associate with obesity can show up also in those who are in the normal body weight category, but are “metabolically obese”.
Metabolic syndrome (basically intolerance of carbohydrates, with insulin resistance and a gradual worsening of blood sugar control) and inflammation are the major “toxic factors” in both obesity and those who are normal weight but with deep belly fat. The increase in health problems that show up in studies on obese people are mostly from metabolic syndrome and inflammation – such as increased hypertension, diabetes, heart attack and stroke (among other impacts). Diabetes then brings its own set of consequences such as kidney disease, eye disease, nerve damage and even further increase in risk for heart attack and stroke. Researchers also feel that the inflammation and the carbohydrate intolerance increase the risk for cognitive dysfunction, dementia and cancer. Most, but not all, people, who struggle with their weight have metabolic syndrome (or show evidence of being headed that way). Most, but not all, people who have normal body weight do not (or not yet) have metabolic syndrome.
The signs of metabolic syndrome can be improved and often reliably and effectively treated by the use of an individually-adjusted carbohydrate-limiting food plan. Also, and critically, most of the benefit of this treatment can be achieved with or without weight loss even close to “normal” range. “Carbohydrates” is the term used for any and all of the sugars and starches in foods. There is carbohydrate intolerance, so lower the intake of total carbohydrates and change the foods eaten to lower the surge of glucose absorbed after a meal. For best benefit, also take other measures to improve carbohydrate tolerance, such as exercise. When carefully applied and adjusted for the individual over time, experienced clinicians find that, almost universally, there is substantial improvement in blood pressure, blood fats and blood sugars and/or insulin levels (among other improvements). (There is consistent clinical experience and some research showing this, more research would help.)
With effective relief from the burden of metabolic syndrome, with its accompanying elevated insulin levels, there is almost always a substantial reduction in excess body fat stores. This is likely related mostly to reductions from previously elevated insulin levels. When insulin levels are high, the body’s metabolic machinery favours turning the carbohydrate you eat into fat and storing it. High insulin levels also strongly resist the release of fat from stores to allow burning it off.
Relief from the damaging effects of metabolic syndrome/insulin resistance are much more important medically than whether there is substantial reduction in body weight. Studies into what is “the best” eating plan to achieve weight loss are off the mark on two counts (1) there will never be a best plan, it will depend on the individual metabolism and circumstances and goals and (2) it is vastly more important to find what are the best set of eating plans that, individually, allow the most protection from the harms associated with obesity, principally from metabolic syndrome and inflammation.
Control of body weight involves countless factors and very complex body systems, so no one intervention will ever be all that is needed. Carbohydrate reduction/restriction is of major importance and benefit for those who have carbohydrate intolerance, but not all people who have high body fat have carbohydrate intolerance. Unfortunately, low carb eating is not enough in itself to result in normal weight in all circumstances. It is not magic. Being on a low carb eating plan does not mean that you are living in a bubble, not affected by all the other factors that affect weight control such as high calories, poor sleep, food addictions, medications that promote weight gain, etc, etc.
If you have metabolic syndrome or a tendency to it, low carb eating can greatly improve your health and greatly improve your weight control while you work on finding the other things you need to do to further improve your weight control.
Nutritional ketosis is a powerful medical tool and can play an important role separate from any carbohydrate intolerance and separate from weight loss.
Low carb eating is actually four medical interventions confused together:
- (1) as a means to protect the body from the various harmful effects of carbohydrate intolerance/insulin resistance (metabolic syndrome), including lowering blood insulin levels to allow a tipping of the balance from fat storage to fat release for burning and
- (2) as a means to maintain abstinence for people who find that they have an addiction-like response to sweet or starchy foods or to fatty foods that are sweet or starchy (they can learn that they do not need to eat any sweet or starchy foods)
- (3) as a means to improve the ability to maintain a stable blood sugar within the healthy range by dietary means with or without the help of medications (in the least dosages, thereby lessening medication adverse effects)
- (4) as a means to be in the metabolic state known as “nutritional ketosis“. Without going into the details here, nutritional ketosis is a normal physiological state that is part of your basic ancient metabolic flexibility. In this state, you are burning fats and a fat-derived substance called “ketones” for almost all of your body needs. In this state you need and burn a very small amount of glucose. This small amount of glucose is critically needed, but your body can make it from protein and you don’t really need any from your food (if your body is working normally – this is not true in certain disease states and with certain medications, such as insulin and others that lower blood glucose).
Are there more than these four types of basic elements of the effects of carb control or low carb eating on health? There is a lot of discussion on this topic, but its too early for conclusions.
By understanding the needs of each unique person in regards to what aspects of carbohydrate control are most important for them, a fully individualised eating plan can be worked out that allows the greatest flexibility and freedom, with the least amount of restriction that achieves their goals and is consistent with their circumstances and informed choices.
Nutritional ketosis is a medical intervention which helps control appetite – independent of whether the person is insulin resistance or not.
Because nutritional ketosis is a tool in itself, it can be targeted more specifically as a goal if the benefits are considered worthwhile in any given person’s situation. This may involve avoiding high intake of protein, use of MCT oil (a coconut oil derivative that readily converts to ketones in the liver), use of metformin to reduce abnormally excessive production of glucose by the liver, and other strategies. (MCT oil is stripped of all other nutrients and could only be used sparingly and thoughtfully as a medical intervention.)
Research and clinical experience over decades have improved the understanding of fully individualised carb-controlled eating as a long-term, essentially permanent lifestyle option, so the medical benefits are available in a sustained way (essentially acting like a long-term medication).
Food addiction-like responses, food triggering and brain sensitization have received increasing attention and come to be understood as key factors in weight control. For people who have addiction responses to foods containing sugars and/or starches, the understanding that full abstinence is an option (there is no health requirement for intake of carbohydrates and they can be avoided except for those consumed daily in salads and non-starchy vegetables) can change their lives.
There is also improved understanding of dis-ordered eating patterns and the eating disorders.
This blog is my contribution towards putting into words the facts, concepts and options at play.
This blog is full of hope and enthusiasm that current new understandings and information, along with the networked communication of informed and determined people, can bring the needed tools into the grasp of many (possibly even most) people even with what we know and can share right now.
Let none be left behind – if you have a particularly difficult time achieving weight loss to your best healthy weight, then we all have something to learn from your journey. I have had a personal life lesson in never, never, never, never, never, never, never, never, never give up and I encourage you (though some days you may need to pause from the striving) to put one try ahead of another. Given the massive research effort and the opportunity the internet gives us to put our heads together, hope is actually a very realistic attitude.
My viewpoint is that all the researchers, clinicians, academics, policy makers and commentators are motivated from a true and honest heart. Each one is striving for the goal of the best health and best fulfillment of life for individuals and for society as a whole. Because there will not ever be one right best answer for weight health, and because not one of us knows yet the full collection of interventions/treatments that will bring access to weight health to all people, there are many different opinions. Passionate discussion and rebuttal is the result. But, “we fight because we care”. Individuals who just want to collect their pay and go home would not waste time and energy on vigorous debate. The more the crisis grows, the more testy the interactions can get. We are all striving for the same goal.
This blog is written mostly from the point of view of the usefulness af low-carbohydrate nutrition – as ONE OF the useful interventions to consider. There are countless factors that act together in determining an individual’s body weight at any particular time. The vast majority of people who struggle with their weight will need to make use of a number of different interventions/treatments/lifestyle changes in their lives to achieve and maintain their desired healthy body composition. Low-carb eating is not the sole intervention needed, nor is it important for all.
I’m not advocating for low-carb eating for all, I am advocating for the best health and fulfilling life for all, by whatever means prove to be best. The proper stance of any physician, researcher, etc., is “let the truth win out”. I write about low-carb nutrition because I think it is critically important that this option be more widely known and better understood. There is a tremendous amount of confusion and mis-information about low-carb nutrition. This is hindering people from achieving what could be life-changing benefits. What I am advocating, also, is that each person be aware that carbohydrate intolerance could be a factor in their health and that they receive knowledgable help, now and over the stages of their lives, in evaluating this impact and what it means for their health and for their food choices.
What I would like to see is carbohydrate awareness and carbohydrate literacy.
Each person’s body weight and composition is their own business. I would like to make a contribution towards improving the degree to which it is also their own free choice.