The Obesity Code

Food is a very emotional issue. There are many depressed people in our country who overeat to cover pain. There are many people who do not love themselves and therefore do not feel they deserve health and do not pursue it. And there are those who are so spiritually asleep that they are somehow not connected enough with their body to know they need to take care of it. There are also, unfortunately, many people who have had unpleasant experiences as children—physical and verbal violations—that make them reluctant to be attractive. For them, extra weight is a protective shield. It insulates them emotionally and prevents them from being involved on a level where there is still a lot of pain. Most of the overweight people I have counselled have psychological issues that must be dealt with. Otherwise, they will not love themselves enough to want health and happiness. This is particularly true for those who are a hundred kilos or more overweight.

For such people, emotional and spiritual solutions are needed first, not a diet or supplements. Then health and happiness and an attractive physique can come into being when the right nutritional strategy is added. For reasons It is often observed that, those who weigh over hundred kilos or more rarely keep their weight off. It has been my experience, that their weight keeps coming back again and again. Those who are emotionally ready to make positive changes fare much better and are able to reduce weight permanently. For them counselling is the key to recovery.

Weight loss or the attainment of optimal health may sound like a simple biochemical thing. It is not. You have to want it to happen. You have to be prepared for happiness emotionally and spiritually, which many people are not. There are changes that will happen in your life when you become optimally healthy that you must be ready for on every level or they will not endure, if they happen at all.

All diets, whether it is the high protein, low carb, low sugar, low-fat, low-calorie, seem to produce weight loss in the short term. They amount lost may vary, but they all seem to work. However, by six to twelve months, the lost weight is regained, despite continued dietary compliance and strict exercise regimen. All diets work because they all address at least some aspect of the disease. But almost all of them fail in the long run, because none of them address the root cause.

All Diets Fail. The Question is Why – The Multifactorial Nature of Obesity

There is no one single cause of obesity. Do calories cause obesity? Yes, partially. Do carbohydrates cause obesity? Yes, partially. Does fiber protect us from obesity? Yes, partially. Does insulin resistance cause obesity? Yes, partially. Does sugar cause obesity? Yes, partially. All these factors individually or collectively, cause hormonal imbalance that leads to weight gain, and insulin is the most important of these. Since all diets whether low-carbohydrate diets, low-calorie diets, low sugar diets, salad and soup diets, reduce insulin, they all lead to weight loss to an extent.

Most diets attack one part of the problem at a time. This approach may be flawed and may not yield desired results. The probability of success is much higher with a broad-based attack. In cardiovascular disease, treating high blood pressure does not mean ignoring smoking. The same approach is necessary to address the multidimensional problem of obesity. For example, if chronic sleep deprivation is the main problem causing weight gain, then decreasing refined grains is not likely to help much. If excessive sugar intake is the problem, then mindfulness meditation is not going to be especially useful.

What to Eat

The long-recognized truth is that certain foods must be severely restricted, including sugar-refined foods, animal proteins, sweetened beverages and sweets. Other foods do not need to be restricted: cabbage or broccoli, for instance. A nutrient dense whole food plant based diet clubbed with regular fasting periods form the basis of an effective weight loss programme. What matters most is quantity, quality, variety and timings.

The Calorie Myth

We believe that when the number of calories we take in exceeds the number of calories we burn, weight gain results. Eating too much and exercising too little causes weight gain, we believe. Eating too many calories causes weight gain, we believe. “Eat Less, Move More,” We have heard it so often that we do not question whether it’s the truth. It seems so self-evident that we do not question whether these beliefs are actually true.

Calories are just one of the factors in the multifactorial disease called obesity. Let’s face the truth. Low-calorie diets have been tried again and again and again. They fail every single time. All these are recipe for failure. After several failed attempts at losing weight, we start believing that the fault lies in us. We feel we have failed and we start criticising ourselves. While some think we have no willpower and offer us meaningless advice, others criticize us for not adhering to the diet.

People on a diet tend to feel hungrier, and that effect isn’t because of lack of willpower. Increased hunger is a normal and expected hormonal response to weight loss. We do not eat too much because we choose to, or because food is too delicious, or or because of salt, sugar and fat. We eat too much because our own brain compels us to.

The Vicious Cycle of Undereating

In desperation, we get into the vicious cycle of under-eating. We start by eating less and actually lose some weight. As a result, our metabolism slows and hunger increases. We start to regain weight. We double our efforts by eating even less. A bit more weight comes off, but again, total energy expenditure decreases and hunger increases. We start regaining weight. So, we redouble our efforts by eating even less. This cycle continues until it becomes intolerable. We are cold, tired, hungry and obsessed about calories. Worst of all, the weight always comes back with a vengeance.

At some point, we go back to our old way of eating. Since metabolism has slowed so much, even resuming the old way of eating causes quick weight gain, up to and even a little past the original point. We are doing exactly what our hormones are influencing us to do. But friends, family, dietician and medical professionals silently blame the victim, thinking that it is “our fault.” And we ourselves get convinced that we are a failure.

All dieters share this same sad story of weight loss and regain. It’s a virtual guarantee. The cycle has been scientifically established, and its truth has been endorsed by millions of dieters. Yet nutritional authorities continue to preach that caloric reduction will lead to nirvana of permanent weight loss.

The Limits of Exercise: A Harsh Reality

Conventionally, Diet and Exercise have been prescribed as treatments for obesity as if they are equally important. But diet and exercise are not fifty-fifty partners. Diet does 95 percent of the work and deserves all the attention; so, logically, it would be sensible to focus on diet. Exercise has great health benefits. There is no doubt about it. Exercise is healthy and important—just not equally important. It has many benefits, but weight loss is not among them. Exercise is like brushing your teeth. It is good for you and should be done every day. Just don’t expect to lose weight.

The fact that exercise always produces less weight loss than expected has been well documented in medical research. Many other longer-term randomized studies have shown that exercise has minimal or no effect on weight loss. When it comes to weight loss, exercise is just not that effective. If we want to reduce obesity, we need to focus on what makes us obese. If we spend all our money, research, time and mental energy focused on exercise, we will have no resources left with which to actually fight obesity.

The Hormonal theory of Obesity

The body maintains a body set weight, much like a fan regulator. When the body set weight is set too high, obesity results. But what caused our body set weight to be so high in the first place,? In other words “What causes obesity?” To find the answer, we need to know how the body set weight is regulated. How do we raise or lower our “body set weight?”

Hormones are chemical messengers that regulate many body systems and processes such as hunger, fat storage and blood sugar levels. Hormonal imbalance is responsible for body set weight. The set weight will decrease or increase depending on the severity of imbalance. If we intend to lose weight, we have to correct the imbalance so that the body set weight comes down. Without this it is impossible to lose weight.

THE MECHANICS OF DIGESTION

Hormones are molecules that deliver messages to a target cell. Insulin delivers the message to most human cells to take glucose inside and use it for energy. To deliver this message, insulin must attach to each cell by binding to receptors on the cell surface, much like a lock and key. Insulin is the key and fits snugly into the lock (the receptor). The door of the cell opens and glucose enters. All hormones work in roughly the same fashion.

When we eat, foods are broken down in the stomach and small intestine. Proteins are broken into amino acids. Fats are broken into fatty acids. Carbohydrates, which are chains of sugars, are broken into smaller sugars. Dietary fiber is not broken down; it moves through us without being absorbed. All cells in the body can use blood sugar (glucose). Certain foods, particularly refined carbohydrates, raise blood sugar more than other foods. The rise in blood sugar stimulates insulin release.

Protein raises insulin levels as well, although its effect on blood sugars is minimal. Dietary fats, on the other hand, tend to raise both blood sugars and insulin levels minimally. Ingested carbohydrate leads to more glucose being available than needed. Insulin helps uptake of glucose into cells for energy. The remaining sugar is stored as glycogen in the liver. We can convert glucose to glycogen and back again quite easily. Without sufficient insulin, glucose builds up in the bloodstream.

The liver has only limited storage space for glycogen. Any remaining sugar left in the blood is converted to fat by insulin. Insulin is a key regulator of energy metabolism, and it is one of the fundamental hormones that promote fat accumulation and storage. Insulin is a storage hormone. Intake of food leads to insulin release. Insulin then turns on storage of sugar in the liver and the remaining sugar is converted to fat.

Several hours after a meal, blood sugars and insulin levels start to drop. Less glucose is available for use by the muscles, the brain and other organs. If we still do not eat, the liver starts to break down glycogen into glucose for energy. This happens most nights and in the early morning assuming you don’t eat at night. This also happens during fasting.

Glycogen is easily available, but in limited supply. When there is no intake of food, insulin levels fall, and burning of this sugar and fat for energy is turned on. During a short- term fasting, your body has enough glycogen available to function. During an extended fast, once the glycogen is used up, fat will be burned to release energy.

This process happens every day. We eat, insulin goes up, and we store energy as glycogen and fat. We fast, insulin goes down and we use our stored glucose or fat for energy. As long as our feeding and fasting periods are balanced, this system also remains balanced. If we eat breakfast at 7 a.m. and finish eating dinner at 7 p.m., the twelve hours of feeding balances the twelve hours of fasting.

Glycogen is like your wallet. Money goes in and out constantly. The wallet is easily accessible, but can only hold a limited amount of money. Fat, however, is like the money in your bank account. It is harder to access that money, but there is an unlimited storage space for energy there in your account. Like the wallet, glycogen is quickly able to provide glucose to the body. However, the supply of glycogen is limited. Like the bank account, fat stores contain an unlimited amount of energy, but they are harder to access.

This situation, of course, partially explains the difficulty in losing accumulated fat. Before getting money from the bank, you spend what’s in your wallet first. But you don’t like having an empty wallet. In the same manner, before getting energy from the Fat Bank, you spend the energy in the Glycogen Wallet. But you also don’t like an empty Glycogen Wallet. So you keep the Glycogen Wallet filled, which prevents you from accessing the Fat Bank. In other words, before you can even begin to burn fat, you start feeling hungry and anxious because your glycogen is becoming depleted. If you continually refill your glycogen stores, you never need to use your fat stores for energy.

What happens to the excess fat that is produced? This newly synthesized fat can be stored as visceral fat (around organs), as subcutaneous fat (underneath the skin) or in theliver (fatty liver).

Under normal conditions, high insulin levels encourage sugar and fat storage. Low insulin levels encourage glycogen and fat burning. Sustained levels of excessive insulin will tend to increase fat storage. An imbalance between the feeding and fasting will lead to increased insulin, which causes increased fat, and obesity.

Could insulin be the hormonal regulator of body weight?

INSULIN, BODY SET WEIGHT AND OBESITY

Body set weight is tightly regulated. Most people’s weight remains relatively stable. Even people who gain weight tend to do so extremely gradually—1 to 2 kgs per year. This does not mean, however, that body set weight is unchanging. Over time, there is a gradual upward resetting of the body’s weight thermostat. The key to understanding obesity is to understand what regulates body set weight, why body set weight is set so high, and how to reset it lower. As a key regulator of energy storage and energy balance, insulin is an obvious suspect as the body set weight regulator. If insulin causes obesity, it must do so predominantly through its effect in the brain. Obesity is controlled in the central nervous system through the body set weight, not in the periphery. In this hypothesis, high insulin levels increase the body set weight.

INSULIN

Can we make anybody fat? Yes. How ? By prescribing insulin. It won’t matter what you choose to eat. You will get fat. It’s simply a matter of enough insulin and enough time. High insulin secretion has long been associated with obesity: obese people secrete much higher levels of insulin than do those of normal weight. We can prove a causal relationship by experimentally giving insulin to a group of people and then measuring their weight gain.

Patients who use insulin regularly and physicians who prescribe it already know the awful truth: the more insulin you give, the more obesity you get. Insulin causes obesity. Numerous studies, conducted mostly on diabetic patients, have already demonstrated this fact. Insulin causes weight gain. Despite eating less than ever, patients gained weight like crazy. It wasn’t calories that drove their weight gain. It was insulin. Reduced caloric intake did not account for the weight loss. The defining element was insulin: its rise and fall corresponded to the rise and fall in weight.

What Went Wrong

Numerous studies suggest that 75 percent of the weight-loss response in obesity is predicted by insulin levels. Not willpower. Not caloric intake. Not exercise. Just insulin. Insulin causes obesity—which means that insulin must be one of the major controllers of the body set weight. As insulin goes up, the body set weight goes up. The hypothalamus sends out hormonal signals to the body to gain weight. We become hungry and eat. If we deliberately restrict caloric intake, then our total energy expenditure will decrease. The result is still the same—weight gain.

Hormones are central to understanding obesity. Everything about human metabolism, including the body set weight, is hormonally regulated. Hormones precisely and tightly regulate body fat. We don’t consciously control our body weight any more than we control our heart rates, our basal metabolic rates, our body temperatures or our breathing. These are all automatically regulated, and so is our weight. Hormones tell us we are hungry (ghrelin). Hormones tell us we are full. Hormones increase energy expenditure (adrenalin). Hormones shut down energy expenditure (thyroid hormone). Obesity is a hormonal dysregulation of fat accumulation.

Once we understand that obesity is a hormonal imbalance, we can begin to treat it. If we believe that excess calories cause obesity, then the treatment is to reduce calories. But this method has already been proven to be a complete failure. However, if too much insulin causes obesity, then it becomes clear we need to lower insulin levels. The question is how to balance our hormones. The most crucial question in obesity is how to reduce insulin.

Cortisol – The Stress Hormone

Anyone can be made fat, by prescribing a synthetic version of the human hormone cortisol. Prednisone is used to treat many diseases, including asthma, rheumatoid arthritis, lupus, psoriasis, inflammatory bowel disease, cancer, glomerulonephritis and myasthenia gravis. And what is one of the most consistent effects of prednisone? Like insulin, it makes you fat. Not coincidentally, both insulin and cortisol play a key role in carbohydrate metabolism. Prolonged cortisol stimulation will raise glucose levels and, subsequently, insulin. This increase in insulin plays a substantial role in the resulting weight gain.

Cortisol is the so-called stress hormone, which mediates the flight or fight response, a set of physiological responses to perceived threats. In ancient times, the stress that led to a release of cortisol was often physical: for instance, being chased by a tiger. Cortisol is essential in preparing our bodies for action—to fight or flee.

Once released, cortisol substantially increases glucose availability, which provides energy for muscles, very necessary in helping us to run and avoid being eaten. All available energy is directed towards surviving the stressful event. Growth, digestion and other long-term metabolic activities are temporarily restricted. Proteins are broken down and converted to glucose. Vigorous physical exertion (fight or flight) soon often followed, burning up these newly available stores of glucose. Shortly thereafter, we were either dead, or the danger was past and our cortisol decreased back to its normal low levels as a result of the activity.

And that’s the point: the body is well adapted to a short-term increase in cortisol and glucose levels. Over the long term, however, a problem arises.

Cortisol Raises Insulin

At First glance, cortisol and insulin appear to have opposite effects. Insulin is a storage hormone. Cortisol, however, prepares the body for action, moving energy out of stores and into readily available forms, such as glucose. That cortisol and insulin would have similar weight-gain effects seems remarkable—but they do. With short-term physical stress, insulin and cortisol play opposite roles. Something quite different happens, though, when we’re under long- term psychological stress.

In our modern-day lives, we have many chronic, nonphysical stressors that increase our cortisol levels. For example, marital issues, problems at work, arguments with children and sleep deprivation are all serious stressors, but they do not result in the vigorous physical exertion needed to burn off the blood glucose. Under conditions of chronic stress, glucose levels remain high and there is no resolution to the stressor. Our blood glucose can remain elevated for months, triggering the constant release of insulin. Chronically elevated cortisol leads to increased insulin levels—as demonstrated by several studies.

Over time, insulin resistance (that is, impairment of the body’s ability to process insulin) also develops, mainly in the liver and skeletal muscle This increased insulin resistance leads back to elevated insulin levels. In a sense, insulin resistance should be expected, since cortisol generally opposes insulin. Cortisol raises blood sugar, while insulin lowers it. Insulin resistance is crucial to the development of obesity. Insulin resistance leads directly to higher insulin levels, and increased insulin levels are a major driver of obesity.

Multiple studies confirm that increasing cortisol increases insulin resistance. If increasing cortisol raises insulin, then reducing cortisol should lower it. We find this effect in transplant patients who take prednisone (the synthetic cortisol) for years or decades as part of their anti-rejection medication. According to one study, weaning them off prednisone resulted in a 25 percent drop in plasma insulin, which translated to a 6.0 percent weight loss and a 7.7 percent decrease in waist girth.

CORTISOL AND OBESITY

Higher cortisol levels were seen in heavier people. Cortisol-related weight gain, particularly abdominal fat deposits, results in an increased waist-to-hip ratio. (This effect is significant because abdominal fat deposits are more dangerous to health than all-over weight gain.)

In other words, substantial evidence indicates that chronic cortisol stimulation increases both insulin secretion and obesity. Therefore, the hormonal theory of obesity takes shape: chronically high cortisol raises insulin levels, which in turn leads to obesity.

And so, by extension, stress causes weight gain—something that many people have intuitively understood, despite the lack of rigorous evidence. Stress contains neither calories nor carbohydrates, but can still lead to obesity. Long-term stress leads to long-term elevated cortisol levels, which leads to extra pounds.

There are many time-tested methods of stress relief, including mindfulness meditation, yoga, massage therapy and exercise. Studies on mindfulness intervention found that participants were able to use yoga, guided meditations and group discussion to successfully reduce cortisol and abdominal fat.

SLEEP

Sleep Deprivation is a major cause of chronic stress today. Population studies consistently link short sleep duration and excess weight. Sleeping five to six hours was associated with a more than 50 percent increased risk of weight gain. The more sleep deprivation, the more weight gained. Sleep Deprivation is a potent psychological stressor and thus stimulates cortisol. This, in turn, results in both high insulin levels and insulin resistance. A single night of sleep deprivation increases cortisol levels by more than 100 percent. Getting enough good sleep is essential to any weight loss plan.

Conventional advice for weight loss.

Eating nutritious plant based whole foods and fasting results in weight loss. Why nobody gives us this advice? Because nobody makes money when you eat less. If you take more supplements, the supplement companies make money. If you drink more milk, the dairy farmers make money. If you eat more cereals, the cereal food companies make money. If you eat more snacks, the snack companies make money. The list goes on and on. Obesity is a hormonal disorder of fat regulation. Insulin is the major hormone that drives weight gain, so the rational therapy is to lower insulin levels. There are multiple ways to achieve this, and we should take advantage of each one.

Long-term Dieting is futile.

When you diet, after the initial weight loss, the body reacts to weight loss by trying to return to its original body set weight. Even if we eat all the right things, our insulin levels stay elevated.

All foods result in insulin production. In order to lose weight permanently, we must have recurrent periods of very low insulin levels. If all foods raise insulin, then the only way for us to lower it is to completely abstain from food. The answer we are looking for is, in a word, fasting.

Fasting is the most efficient and consistent strategy to decrease insulin levels, a fact first noted decades ago and widely accepted as true. All foods raise insulin; therefore, the most effective method of reducing insulin is to avoid all foods. Blood glucose levels remain normal as the body switches over to burning fat for energy. This effect occurs with fasting periods as short as sixteen hours to thirty-six hours. Longer fasts reduce insulin even more dramatically. More recently, alternate daily fasting has been studied as an acceptable technique for reducing insulin levels.

Fasting may be done for any period of time, from a few hours to a few weeks. In a sense, fasting is part of everyday life. The human body is well adapted for dealing with the absence of food. What we’re describing here is the process the body undergoes to switch from burning glucose (short term) to burning fat (long term). Fat is simply the body’s stored food energy. In times of food scarcity, stored food (fat) is naturally released to fill the void. The body does not “burn muscle” in an effort to feed itself until all the fat stores are used. It’s crucial to note that all these beneficial adaptive changes do not occur in the caloric-reduction diet strategy.

Regular fasting, by routinely lowering insulin levels, has been shown to significantly improve insulin sensitivity. This finding is the missing piece in the weight-loss puzzle. Most diets restrict the intake of foods that cause increased insulin secretion, but don’t address insulin resistance. You lose weight initially, but insulin resistance keeps your insulin levels and body set weight high. By fasting, you can efficiently reduce your body’s insulin resistance, since it requires both persistent and high levels.

Fasting is often accompanied by an early, rapid weight loss. For the first five days, weight loss averages 1 kg per day, and is probably due to diuresis. Diuresis reduces bloating and may also lower blood pressure slightly. Glucose and fat are the body’s main sources of energy. When glucose is not available, then the body adjusts by using fat, without any health detriment, resulting in weight loss.

Obesity is a hormonal disorder of fat regulation : Insulin is the major hormone that drives weight gain, so the rational therapy is to lower insulin levels. There are multiple ways to achieve this, and we should take advantage of each one.

To sum it up, following are the key factors that regulate long term weight

Calorie consumption (partially)
Exercise (partially)
Stress
Sleep pattern
Liver and colon health
Processed and packaged foods
Animal Protein and dairy consumption
Eating timings and habits

How to achieve a permanent weight loss that never returns

Detoxification of the elimination pathways, namely liver, kidney and colon
Eating nutritious wholefood plant-based diet
Totally eliminating Animal protein including dairy in any form
Totally eliminating packaged and processed foods
Fasting (without this every diet protocol fails)
Reducing stress
Healthy sleep pattern

Reference

Dr. Jason Fung is a Toronto physician specializing in the care of patients with kidney diseases. The above article is inspired and referenced from his book “The Obesity Code: unlocking the secrets of weight loss.