THERE ARE TWO prominent findings from all the dietary studies done over the years. First: all diets work. Second: all diets fail.
What do I mean? Weight loss follows the same basic curve so familiar to dieters. Whether it is the Mediterranean, the Atkins or even the old fashioned low-fat, low-calorie, all diets in the short term seem to produce weight loss. Sure, they differ by amount lost—some a little more, some a little less. But they all seem to work.
However, by six to twelve months, weight loss plateaus, followed by a relentless regain, despite continued dietary compliance. In the ten-year Diabetes Prevention Program,1 for example, there was a 15.4-pound (7-kilogram) weight loss after one year. The dreaded plateau, then weight regain, followed.
So all diets fail. The question is why.
Permanent weight loss is actually a two-step process. There is a short-term and a long-term (or time-dependent) problem. The hypothalamic region of the brain determines the body set weight—the fat thermostat. (For more on body set weight, Insulin acts here to set body set weight higher. In the short term, we can use various diets to bring our actual body weight down. However, once it falls below the body set weight, the body activates mechanisms to regain that weight—and that’s the long-term problem.
This resistance to weight loss has been proven both scientifically and empirically.2 Obese persons that had lost weight required fewer calories because their metabolisms had slowed dramatically and desire to eat accelerates. The body actively resists long-term weight loss.
THE MULTIFACTORIAL NATURE OF DISEASE
THE MULTIFACTORIAL NATURE of obesity is the crucial missing link. 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 converge on several hormonal pathways that lead to weight gain, and insulin is the most important of these. Low-carbohydrate diets reduce insulin. Low-calorie diets restrict all foods and therefore reduce insulin.
Paleo and LCHF diets (low in refined and processed foods) reduce insulin. Cabbage-soup diets reduce insulin. Reduced-food-reward diets reduce insulin.
Virtually all diseases of the human body are multifactorial. Consider cardiovascular disease. Family history, age, gender, smoking, high blood pressure and physical activity all influence, perhaps not equally, the development of heart disease.
Cancer, stroke, Alzheimer’s disease and chronic renal failure are all multifactorial diseases.
Obesity is also a multifactorial disease. What we need is a framework, a structure, a coherent theory to understand how all its factors fit together. Too often, our current model of obesity assumes that there is only one single true cause, and that all others are pretenders to the throne. Endless debates ensue.
Too many calories cause obesity. No, too many carbohydrates. No, too much saturated fat. No, too much red meat. No, too much processed foods. No, too much high fat dairy. No, too much wheat. No, too much sugar.
No, too much highly palatable foods. No, too much eating out. It goes on and on. They are all partially correct.
So the low-calorie believers disparage the LCHF people. The LCHF movement ridicules the vegans. The vegans mock the Paleo supporters. The Paleo followers deride the low-fat devotees.
All diets work because they all address a different aspect of the disease. But none of them work for very long, because none of them address the totality of the disease. Without understanding the multifactorial nature of obesity—which is critical—we are doomed to an endless cycle of blame.
Most dietary trials are fatally flawed by this tunnel vision. Trials comparing low-carb to low-calorie diets have all asked the wrong question. These two diets are not mutually exclusive.
What if both are valid? Then there should be similar weight loss on both sides. Low-carb diets lower insulin. Lowering insulin levels reduces obesity.
However, all foods raise insulin to some degree. Since refined carbohydrates often make up 50 percent or more of the Standard American Diet, low-calorie diets generally result in a reduced carbohydrate intake. So low-calorie diets, by restricting the total amount of food consumed, still work to lower insulin levels. Both will work – at least in the short term.
That is exactly what Harvard professor Dr. Frank Sacks confirmed in his randomized study of four different diets. Despite differences in carbohydrate, fat and protein content, albeit relatively minor, weight loss was the same. Maximum weight loss occurred at six months, with gradual regain thereafter.
STEP 1: REDUCE YOUR CONSUMPTION OF ADDED SUGARS
SUGAR STIMULATES INSULIN secretion, but it is far more sinister than that. Sugar is particularly fattening because it increases insulin both immediately and over the long term. Sugar is comprised of equal amounts of glucose and fructose, and fructose contributes directly to insulin resistance in the liver.
Over time, insulin resistance leads to higher insulin levels.
Therefore, sucrose and high fructose corn syrup are exceptionally fattening, far in excess of other foods. Sugar is uniquely fattening because it directly produces insulin resistance.
With no redeeming nutritional qualities, added sugars are usually one of the first foods to be eliminated in any diet.
Many natural, unprocessed whole foods contain sugar. For example, fruit contains fructose, and milk contains lactose. Naturally occurring and added sugars are distinct from one another. The two key differences between them are amount and concentration.
Obviously, first you should remove your sugar bowl from your table. There is no reason to add sugar to any food or beverage. But sugars are often hidden in the preparation of food, which means that avoiding sugar is often difficult and you can ingest a surprisingly large amount without knowing it.
Sugars are often added to foods during processing or cooking, which presents dieters with several potential pitfalls. First, sugars may be added in unlimited amounts. Second, sugar may be present in processed food in much higher concentrations than in natural foods.
Some processed foods are virtually 100 percent sugar. This condition almost does not exist in natural foods, with honey possibly being the exception.
Candy is often little more than flavored sugar. Third, sugar may be ingested by itself, which may cause people to overeat sugary treats, as there is nothing else within the food to make you “full.” There is often no dietary fiber to help offset the harmful effects.
For these reasons, we direct most of our efforts toward reducing added, rather than natural sugars in our diet.
Read the labels
ALMOST UBIQUITOUS IN refined and processed foods, sugar is not always labeled as such. Other names include sucrose, glucose, fructose, maltose, dextrose, molasses, hydrolyzed starch, honey, invert sugar, cane sugar, glucose-fructose, high fructose corn syrup, brown sugar, corn sweetener, rice/corn/cane/maple/malt/golden/palm syrup and agave nectar.
These aliases attempt to conceal the presence of large amounts of added sugars. A popular trick is to use several different pseudonyms on the food’s label. This trick prevents “sugar” from being listed as the first ingredient.
The addition of sugar to processed foods provides almost magical flavor-enhancing properties at virtually no cost. Sauces are serial offenders. Barbeque, plum, honey garlic, hoisin, sweet and sour, and other dipping sauces contain large amounts of sugar. Spaghetti sauce may contain as much as 10 to 15 grams of sugar (3 to 4 teaspoons).
This counters the tartness of the tomatoes, and therefore may not be
immediately evident to your taste buds. Commercial salad dressings and condiments such as ketchup and relish often contain lots of sugar. The bottom line is this: If it comes in a package, it probably contains added sugar.
Asking how much sugar is acceptable is like asking how many cigarettes are acceptable. Ideally, no added sugar at all would be best, but that probably will not happen. Still, see the next section for some reasonable suggestions.
What to do about dessert
MOST DESSERTS ARE easily identified and eliminated from your diet. Desserts are mostly sugar with complementary flavors added.
Examples include cakes, puddings, cookies, pies, mousses, ice cream, sorbets, candy and candy bars.
So what can you do about dessert? Follow the example of traditional societies. The best desserts are fresh seasonal fruits, preferably locally grown.
A bowl of seasonal berries or cherries with whipped cream is a delicious way to end a meal. Alternatively, a small plate of nuts and cheeses also makes for a very satisfying end to a meal, without the burden of added sugars.
Dark chocolate with more than 70 percent cacao, in moderation, is a surprisingly healthy treat. The chocolate itself is made from cocoa beans and does not naturally contain sugar.
(However, most milk chocolate does contain large amounts of sugar.)
Dark and semisweet chocolate contain less sugar than milk or white varieties. Dark chocolate also contains significant amounts of fiber and antioxidants such as polyphenols and flavanols.
Studies on dark-chocolate consumption indicate that it may help reduce blood pressure,5 insulin resistance and heart disease. Most milk chocolates, by contrast, are little more than candies. The cacao component is too small to be beneficial.
Nuts, in moderation, are another good choice for an after-dinner indulgence. Most nuts are full of healthful monounsaturated fats, have little or no carbohydrates, and are also high in fiber, which increases their potential benefit. Macadamia nuts, cashews and walnuts can all be enjoyed.
Many studies show an association between increased nut consumption and better health, including reducing heart disease and diabetes.
Pistachio nuts, high in the antioxidant gamma-tocopherol and vitamins such as manganese, calcium, magnesium and selenium, are widely eaten in the Mediterranean diet.
A recent Spanish study found that adding 100 pistachios to one’s daily diet improved fasting glucose, insulin and insulin resistance.
That is not to say that sugar cannot be an occasional indulgence. Food has always played a major role in celebrations—birthdays, weddings, graduations, Christmas, Thanksgiving, etc. The key word here is occasional.
Dessert is not to be taken every day.
Be aware, though, that if your goal is weight loss, your first major step must be to severely restrict sugar.
Don’t replace sugar with artificial sweeteners, as they also raise insulin as much as sugar and are equally prone to causing obesity.
immediately evident to your taste buds. Commercial salad dressings and condiments such as ketchup and relish often contain lots of sugar. The bottom line is this: If it comes in a package, it probably contains added sugar.
Asking how much sugar is acceptable is like asking how many cigarettes are acceptable. Ideally, no added sugar at all would be best, but that probably will not happen. Still, see the next section for some reasonable suggestions.
. Studies on dark-chocolate consumption indicate that it may help reduce blood pressure,5 insulin resistance and heart disease.
Most milk chocolates, by contrast, are little more than candies. The cacao component is too small to be beneficial.
Nuts, in moderation, are another good choice for an after-dinner indulgence.
Most nuts are full of healthful monounsaturated fats, have little or no carbohydrates, and are also high in fiber, which increases their potential benefit. Macadamia nuts, cashews and walnuts can all be enjoyed.
Many studies show an association between increased nut consumption and better health, including reducing heart disease and diabetes.
Pistachio nuts, high in the antioxidant gamma-tocopherol and vitamins such as manganese, calcium, magnesium and selenium, are widely eaten in the Mediterranean diet.
A recent Spanish study found that adding 100 pistachios to one’s daily diet improved fasting glucose, insulin and insulin resistance.
THE HEALTHY SNACK is one of the greatest weight-loss deceptions. The myth that “grazing is healthy” has attained legendary status.
If we were meant to “graze,” we would be cows. Grazing is the direct opposite of virtually all food traditions. Even as recently as the 1960s, most people still ate just three meals per day.
Constant stimulation of insulin eventually leads to insulin resistance. (For more on the dangers of snacking,
The solution? Stop eating all the time.
Snacks are often little more than thinly disguised desserts. Most contain prodigious amounts of refined flour and sugar.
These pre-packaged conveniences have taken over the supermarket shelves. Cookies, muffins, pudding, Jell-O, fruit roll-ups, fruit leather, chocolate bars, cereal bars, granola bars and biscuits—all are best avoided. Rice cakes, advertising themselves as low fat, compensate for lack of taste with sugar. Canned or processed fruit conceals buckets of sugar behind the healthy image of the fruit. A serving of Mott’s Applesauce contains 5½ teaspoons of sugar (22 grams). A serving of canned peaches contains 4½ teaspoons of sugar (18 grams).
Are snacks necessary? No. Simply ask yourself this question. Are you really hungry or just bored? Keep snacks completely out of sight. If you have a snack habit, replace that habit loop with one that is less destructive to your health. Perhaps a cup of green tea in the afternoon should be your new habit. There’s a simple answer to the question of what to eat at snack time. Nothing. Don’t eat snacks. Period. Simplify your life.
Make breakfast optional
BREAKFAST IS, WITHOUT question, the most controversial meal of the day. The advice to eat something, anything, as soon as you step out of bed is often heard. But breakfast needs to be downgraded from “most important meal of the day” to “meal.” Different nations have different breakfast traditions. The big “American” breakfast contrasts directly with the French “petit dejeuner” or “small lunch.” The key word here is “small.”
The greatest problem is that, like snacks, breakfast foods are often little more than dessert in disguise, containing vast quantities of highly processed carbohydrates and sugar.
Breakfast cereals, particularly those that target children, are among the worst offenders. On average, they contain 40 percent more sugar than those that target adults.
Not surprisingly, almost all cereals for children contain sugar, and ten contain more than 50 percent sugar by weight. Only 5.5 percent met the standard for “low sugar.”
In the diets of children under age eight, breakfast cereals rank behind only candy, cookies, ice cream and sugared drinks as a source of dietary sugar.
A simple rule to follow is this: Don’t eat sugared breakfast cereal. If you must, eat cereals containing less than 0.8 of a teaspoon (4 grams) of sugar per serving.
Many breakfast items from the bakery are also highly problematic: muffins, cakes, Danishes and banana bread.
Not only do they contain significant amounts of refined carbohydrates, they are often sweetened with sugars and jams. Bread often contains sugar and is eaten with sugary
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