The behaviors associated with the rise in obesity include increased consumption of sugar-sweetened beverages and decreased consumption of whole fruits, vegetables, and other sources of dietary fiber. On a societal level, obesity is also associated with less breastfeeding, skipped breakfasts, fewer family meals, and more fast food dining.
we have high-quality protein (such as egg protein), which may reduce appetite, and we have low-quality protein (hamburger meat), which is full of branched-chain amino acids (see chapter 9), which has been associated with insulin resistance and metabolic syndrome.
There are two classes of carbohydrate: starch and sugar. Starch is made up of glucose only, which is not very sweet and which every cell in the body can use for energy. Although there are several other “sugars” (glucose, galactose, maltose, and lactose), when I talk about sugar here (and in the rest of this book), I am talking about the “sweet” stuff, sucrose and high-fructose corn syrup, which both contain the molecule fructose. Fructose is very sweet and is inevitably metabolized to fat
Even India, which continues to have an enormous problem with malnutrition, is not immune—since 2004, the number of overweight children increased from 17 percent to 27 percent.
Anthony Cashmore of the University of Pennsylvania recently proposed that free will was in reality an interaction between our DNA and our environment, along with some stochastic (random) processes.
Insulin then tops off the liver’s energy reserve by making liver starch (called glycogen), and shunts any amino acids from the blood into muscle cells. Excess fatty acids, or blood lipids, are cleared into fat cells for storage for a “rainy day,” where they get turned into greasy triglycerides (such as the fat surrounding your steak). There is no energy storage without insulin—it is the key that unlocks the door to the fat cell to let energy enter and subsequently be stored as fat. Insulin makes fat—the more insulin, the more fat. And there it sits…and sits…as long as there is insulin around. When the insulin levels drop, the process goes in reverse: the triglycerides get broken down, causing the fat cells to shrink—when it happens, that’s weight loss!—and the fatty acids reenter the bloodstream and travel back to the liver, where they are burned by the liver or other organs.
Leptin is a protein made and released by fat cells. It circulates in the bloodstream, goes to the hypothalamus, and signals the hypothalamus that you’ve got enough energy stored up in your fat.
Leptin tells the VMH that you have enough energy on board to burn the excess, feel good, reduce your long-term food intake, and remain weight stable. When your leptin signal works, you’re in energy balance, burning energy at a normal rate and feeling good.
leptin resistant.8 Their hypothalami can’t see their leptin, so their brains think they’re starving, and will therefore try to increase energy storage (gluttony) and conserve energy usage (sloth).
leptin concentrations drop precipitously during periods of short-term fasting (within twelve hours), declining faster than body fat stores. You haven’t lost any weight in that time, but your fat cells are already telling your brain you’re starving, driving your food intake back up. By the time you’re one day into any weight-loss regimen you’re already leptin deficient on top of being leptin resistant, meaning, you really can’t see the signal.
In a nutshell, this is the recidivism of obesity. If your brain thinks there’s no leptin (due to either leptin deficiency or leptin resistance) you’re pretty miserable. Your sympathetic nervous system goes into conservation mode, driving down your energy expenditure, physical activity, and quality of life. Your vagus nerve then goes into overdrive, driving up your appetite, your insulin, and your energy storage.
Obesity is a biochemical alteration in the brain promoting leptin resistance with resultant weight gain and secondary changes in behavior to maintain energy balance. The apparent character defects of gluttony and sloth are not the cause of the problem; they are the result of the problem.
The linchpin in this biochemical alteration is the hormone insulin. The majority of humans, regardless of weight, release double the insulin today that we did thirty years ago for the same amount of glucose.
Our brains are wired for reward—it is the primary force behind human survival. Reward is the reason to get up in the morning. If you take away reward, you take away the reason to live.
With time we can become sensitized to a substance and need more of it to get the same effect. Once sensitized, animals and humans may become hyperresponsive to a new substance; this is known as cross-sensitization. In other words, if the brain has been wired for addiction, it’s easy to switch from one substance to another. Ask recovering alcoholics about their incessant need for coffee, tobacco, and/or sugar.
In animals, anxiety and depression are indicated by unwillingness to spend time in a risky environment. In humans, withdrawal is expressed as symptoms of depression and anxiety.
In humans, food addiction is often compared to established criteria for substance dependence.7 One problem with this approach is that it shifts focus away from the potentially addictive properties of the food and onto the individual “afflicted” with the addiction.
Fast food is high in calories, sugar, fat, salt, and caffeine. It is highly processed, energy dense, and specifically designed to be highly palatable. The majority of the fiber and a portion of the vitamins and minerals present in the original food have been extracted in processing
The late comedian and social commentator George Carlin famously referred to coffee as “Caucasian crack.”
perhaps the best evidence for an opiate-like effect of sugar is the product Sweet-Ease. This is a sugar solution into which hospitals dip pacifiers for newborn boys undergoing circumcision, to reduce the pain of the procedure.
Evolutionarily, sweetness was the signal to our ancestors that something was safe to eat because no sweet foods are acutely poisonous.
How many times do parents have to introduce a new food before a baby will accept it? About ten to thirteen times. But if that new food is sweet, how many times do you have to introduce it? Only once.
Happiness is not just an aesthetic state. Happiness is also a biochemical state, mediated by the neurotransmitter serotonin. The “serotonin hypothesis” argues that deficiency of brain serotonin causes severe clinical depression, which is why selective serotonin reuptake inhibitors (SSRIs) which increase brain serotonin, such as Wellbutrin and Prozac, are used as treatment.
One way to increase serotonin synthesis in the brain is to eat lots of carbohydrates.
If pressures (social, familial, cultural, etc.) are relentless, the stress responses remain activated for months or even years. When cortisol floods the bloodstream, it raises blood pressure; increases the blood glucose level, which can precipitate diabetes; and increases the heart rate. Human research shows that cortisol specifically increases caloric intake of “comfort foods” (e.g., chocolate cake).3 And cortisol doesn’t cause just any old weight gain. It specifically increases the visceral fat (see chapter 8), which is the fat depot associated with cardiovascular disease and metabolic syndrome.
“Stressed” Is “Desserts” Spelled Backward
Human research shows that cortisol specifically increases caloric intake of “comfort foods” (those with high energy density or high fat and high sugar).
The perception of chronic stress causes increased caloric intake of “comfort foods,” but only among those with high cortisol reactivity. People who are “stress eaters” exhibit significant increases in insulin, weight, and cortisol at night (normally the time for cortisol to be very low) during a stressful period.
One outcome of stress is reduced sleep, which is both a contributor to and a consequence of obesity. We’re all getting less sleep than we used to, especially children (Janie included).9 BMI increases over time among short sleepers.
Sleep deprivation has been shown to increase cortisol and reduce leptin, and in doing so, mimic starvation and hunger.
Thus the stress and reward systems are linked, making food addiction among those who eat to manage their stress a faît accompli.
In short—insulin makes you gain weight, while cortisol tells you where to put it.
Why should cortisol lay down fat in the abdomen, where it is more likely to cause disease (see chapter 8), as opposed to your love handles?
Belly fat breaks down into fatty acids faster, and has a direct line to the liver for burning. So having some extra energy that you could “mainline” right into your liver was adaptive, when the stresses were physical.
We call this model the “limbic triangle”—similar to the Bermuda Triangle: once you get in, you can’t get out.13 Chronic insulin action at the VMH inhibits leptin signaling, which is interpreted as starvation. This decreases SNS activity (sloth) and increases vagal activity (hunger). In the VTA, chronic insulin deregulates hedonic reward pathways by inhibiting leptin signaling (reward). You want to eat more, especially high-fat and high-sugar treats, which results in excessive energy intake. Chronic activation of the amygdala increases levels of cortisol (stress). By itself, this promotes excess food intake and insulin resistance, ratcheting up insulin levels and accelerating weight gain.
We now assume that a hostile intrauterine environment (undernutrition, overnutrition, or maternal stress) transmits some signal to the fetus, which conveys information about future threat: It’s a tough world out there, kid; best be ready for it. This drives the infant to store extra energy and increase its fat after birth when there is no need to do so, to the ultimate detriment of health later on.
The child is “programmed” for survival at the expense of longevity.
Bottom line, once a glucose molecule is in the bloodstream it has one of three fates: it can be burned (by exercise), it can be stored in fat (by insulin), or it can be excreted in the urine (which eventually kills your kidneys).
Caucasians start showing metabolic wear and tear at a BMI of around 30, which is why epidemiologists chose 30 as the obesity breakpoint. However, African Americans don’t show metabolic decompensation until a BMI of about 35, while Asians start to manifest disease at a BMI of around 25.
Believe it or not, more subcutaneous fat is better for your health. Several studies show that the size of the subcutaneous fat depot correlates with longevity.
The only compartment that is consistently bad for us is our visceral (aka abdominal, ectopic, or “big belly”) fat. This consists of fat in areas where it doesn’t belong, including fat inside your abdomen and inside your organs (e.g., liver and muscle).
Visceral fat causes insulin resistance, which in turn promotes diabetes, cancer, cardiovascular disease, dementia, and aging. While the populace is more worried about subcutaneous fat (because it’s unsightly), this fat is much less prone to being lost; in fact, it is rarely shed unless you go on a caloric restriction or starvation diet, which is rarely sustainable.
Obesity is a “marker” for metabolic syndrome, but not the only marker; it is not the cause. Whether it resides in fat people or not, the one thing everyone seems to agree on is that insulin resistance is the hallmark of metabolic syndrome.
Insulin is one of the hormones that cause cells to divide. Hyperinsulinemia is associated with the development and growth of various forms of cancer.
Third, the liver has to deal with excess energy, which may arrive in several forms: as fatty acids from digestion of dietary fat or as amino acids from the digestion of protein, the consumption of alcohol, or from the molecule fructose (which is half sucrose, or table sugar, and roughly half high-fructose corn syrup).
Trans fats used to be in every processed food, although slowly they are leaving our diet. But they are still in baked goods and candy bars. In fact, any food in a wrapper at room temperature that’s meant to sit on a store shelf is suspect.
Alcohol is interesting because a small daily ration, especially when consumed as wine, has been shown to prevent metabolic syndrome.
But increased consumption of booze clearly contributes to metabolic syndrome’s development. Furthermore, alcoholic beverages that also contain glucose, such as beer and shochu (a Japanese fermented drink) have been clearly implicated in the promotion of metabolic syndrome in America and Japan, respectively.
Here’s some food for thought. With very few exceptions, every naturally occurring foodstuff contains either fat or carbohydrates, but usually not both. Meat, fish, and poultry have no carbohydrates. Grains, roots, and tubers (e.g., potatoes and yams) have no fat. Those fruits that have fat, such as avocados, olives, and coconut, have minimal carbohydrates. Nuts are an exception, but they are still pretty low in carbohydrates and very high in fiber.
the English diet, which consisted of incredibly high fat and high cholesterol items. (Think bangers and mash, fish and chips.)
“indigenous tribes,” such as the Inuit (North America), Tokelau (Oceania), and Maasai and Rendille (both Africa), who ate only animal fat and have among the lowest prevalence of heart disease on the planet. 2.
small dense LDL doesn’t float; it sinks. It’s small enough to get underneath the blood vessel cells and has been specifically implicated in the start of atherosclerotic plaques. True, dietary fat raises LDL, but it’s the large buoyant kind. The small dense variation is raised by carbohydrates.7
Dietary Fats and Their Value, in Descending Order, to Human Health Dietary Fat Dietary Source Medicinal Value or Danger Omega-3 fatty acids Wild fish, flaxseed oil Anti-inflammatory, lowers serum triglycerides, repairs membranes Monounsaturates Olive and canola oil Stimulates liver metabolism, reduces atherogenesis Polyunsaturates Vegetable oils Anti-inflammatory, but in excess amounts can cause immune dysfunction Saturated fatty acids Grass-fed animal meats, milk and dairy products Atherogenic in a specific genetic background (familial hypercholesterolemia, or FH); raises levels of type A LDL very high Medium-chain triglycerides Palm oil, coconut oil, palm kernel oil Energy source, some suggestion of stimulation of atherosclerosis Omega-6 fatty acids Farm-raised animals and fish (fed on corn and soy) Atherosclerosis, insulin resistance, immune dysfunction, pro-inflammatory Trans fats (partially hydrogenated oils) Synthetic, found in processed foods only Atherosclerosis, nonalcoholic fatty liver disease
What do the Atkins diet (protein and fat), the Ornish diet (vegetables and whole grains), and the traditional Japanese diet (carbohydrate and protein) have in common? On the surface they seem to be diametrically opposite. But they all have one thing in common: they restrict sugar.
sugar, despite ostensibly being a carbohydrate, is really both a fat (because that’s how fructose is metabolized in the liver) and a carbohydrate (because that’s how glucose is metabolized) all rolled into one. Both pathways have to work overtime, which is why sugar is the real omnivore’s dilemma.
if you’re starving and energy-depleted, consuming sugar can replete your liver’s glycogen stores more rapidly, which can be beneficial. So offensive linemen after three hours on the gridiron can consume all the Gatorade they want. But the overwhelming majority of people are neither starving nor energy-depleted
The upper threshold of 200 calories per day of sugar, advocated by the American Heart Association in its scientific statement for optimal cardiovascular health,
The fruit is good for you, because it also contains fiber (see chapter 12). In fact, calorie for calorie, 100 percent orange juice is worse for you than soda, because the orange juice contains 1.8 grams of fructose per ounce, while the soda contains 1.7 grams of fructose per ounce.
Upon ingestion of 120 calories of ethanol (e.g., a 1.5-ounce shot of 80-proof hard spirits), 10 percent (12 calories) is metabolized within the stomach and intestine (called the first-pass effect) and 10 percent is metabolized by the brain and other organs. The metabolism in the brain is what leads to the alcohol’s intoxicating effects.
Ghrelin, a peptide produced by cells in the stomach, is the “hunger” signal. In humans, ghrelin levels rise with increasing subjective hunger, peak at the time of voluntary food consumption (which is why your stomach grumbles at noon), and decrease after a meal. However, fructose intake does not decrease ghrelin; therefore, caloric intake is not suppressed. Indeed, fructose consumption in the form of a Big Gulp does not reduce the volume of solid food needed to feel satiated, multiplying the total calories consumed during the meal.
She told me, “I don’t understand how this can happen. We are Indian, we are vegans at home.” However, the family consumes large volumes of “white foods” such as naan, rice, potatoes, and processed starches. Almost completely lacking from their diet are “brown foods” such as lentils, garbanzo beans, and whole grain products. Like many teenagers, Sujatha refuses to eat her vegetables. Beverages consist of soda and juice, and virtually no water. The fiber content of their diet is close to zero.
Table 12.1: Sources of Dietary Fiber Soluble Fiber (absorbs water) Insoluble Fiber (doesn’t absorb water) oatmeal, oat cereal, lentils, apples, oranges, pears, oat bran, strawberries, nuts, flaxseeds, beans, dried peas, blueberries, psyllium, cucumbers, and carrots whole wheat, whole grains, wheat bran, corn bran, seeds, nuts, barley, couscous, brown rice, bulgur, zucchini, celery, broccoli, cabbage, onions, tomatoes, celery, carrots, cucumbers, green beans, dark leafy vegetables, fruit, and root vegetable skins
The starch (endosperm) is on the inside. The bran is on the outside. The whole kernel represents a source of insoluble fiber. Strip away the outside bran, and you are left only with the starch (glucose). When you ingest the whole kernel, your intestines will slowly strip away the outside bran, making the rise in serum glucose occur slowly and reach a lower peak concentration. But when the outside bran is removed by processing, your liver is hit with an influx of glucose and the rise occurs quickly, with a higher peak. And that means a higher insulin peak.
One current fad is to juice the entire fruit into a “smoothie.” Juice bars have popped up all over the West Coast, ostensibly because juicing is healthy. The problem is that the shearing action of the blender blades completely destroys the insoluble fiber of the fruit. The cellulose is torn to smithereens. While the soluble fiber is still there, and can help move food through the intestine faster, it now does not have the “latticework” of the insoluble fiber to help form that intestinal barrier. The sugar in the fruit will be absorbed just as fast as if the juice were strained with no fiber at all. You need both types of fiber to derive the beneficial effects.
In other words, the two elements to keep in mind are: the dose of carbohydrate (to keep the insulin down) and the flux of carbohydrates (to keep the liver happy and functioning properly). Fiber takes care of both.
the glucose in sugar drives the insulin up, while the fructose brings a huge dose of energy straight to the liver for immediate processing, both of which drive obesity and metabolic syndrome
Once fiber (soluble and insoluble) is consumed with a meal, it forms a gelatinous barrier between the food and the intestinal wall. This delays the intestine’s ability to absorb glucose, fructose, and fat. By slowing glucose absorption, the blood glucose rise is attenuated, which limits the peak glucose. In return, the pancreas, sensing the slower and lower rise in blood glucose, limits its response and reduces the amount of insulin released. Less insulin means less shunting of energy to fat.
Not only does fiber reduce the dose, it reduces the “flux”—that is, the rate at which fructose is absorbed and arrives at the liver cell for processing. The liver then has a chance to “catch up” and is able to process the fructose molecules to acetyl-CoA at essentially the same rate that new ones are being introduced. This allows them to burn in the mitochondrial Krebs cycle (see chapter 10), instead of overwhelming the mitochondria, to be shunted out and turned into fat, causing subsequent insulin resistance.
Food in the stomach reduces ghrelin levels, which should tell the hypothalamus that you’re not hungry anymore. But you still are. The reason is that lack of hunger isn’t the same phenomenon as satiety.
After food moves through the small intestine, a hormone called peptide YY(3-36) (PYY) is released into the bloodstream, which binds to receptors in the hypothalamus and tells you that you’re full. PYY is the satiety signal.
The human body contains about ten trillion cells. But your gut harbors about a hundred trillion bacteria. They outnumber us ten to one!
High-fiber foods tend to be less “energy dense,” so you are consuming fewer calories for the same quantity of food. Also they often require more time to chew, giving your body more time to receive its satiety signal, and they move the food through the intestine faster, generating the satiety signal sooner.
Exercise is the single best thing you can do for yourself. It’s way more important than dieting, and easier to do. Exercise works at so many levels—except one: your weight.
behavior is a result of biochemistry, and biochemistry is a result of environment.
the Harris-Benedict equation, a guesstimate used by dietitians to generate dietary plans for individual patients.
As REE accounts for the majority of energy expenditure, this is the greatest predictor of weight gain.
Many obese children are not hungry when they awaken (in part because many of them had a big snack or meal just before bedtime), so their body’s degree of energy burning is not ratcheted up prior to their departure for school. This is one reason, among many, that eating breakfast is important for prevention and treatment of obesity, especially in children (see chapter 18). Not eating breakfast has many other disadvantages. It means not performing well on tasks because of distraction due to lack of food. Not eating breakfast means the stomach hormone ghrelin, which conveys the signal for hunger, is not suppressed throughout the morning.
Another way to take advantage of TEF to is to consume some form of protein at breakfast. Burning protein costs more energy than burning other foodstuffs.5 Protein does not stimulate insulin to the same extent as carbohydrates do, and increases satiety better than other nutrients. So consuming some protein at breakfast is a smart and very defensible practice. People who eat veggie omelets at breakfast are way less hungry at lunchtime.6
That’s because exercise increases the number of mitochondria in the form of increased muscle. And increased muscle means you burn more energy at rest. So Michael Phelps has a higher REE than you do. And that’s why exercise is good; because it builds muscle, and muscle burns energy even at rest.
Diet is about pounds, exercise is about inches.
It will not cure obesity, but it goes a long way toward mitigating all its negative effects, especially those of metabolic syndrome
To reduce your blood pressure, you may want to consider exercise—not because your weight will go down, but because exercising will reduce your stress levels and release endorphins
Four factors have been shown to speed up the liver’s Krebs cycle: cold, altitude, the thyroid hormone (we gave extra thyroid hormone to obese women back in the 1960s and it made them crazy), and exercise. Cold and altitude are a potent anti-obesity combination.
Every molecule of energy that you absorb has one of three fates: First, you can burn it, in which case your insulin doesn’t rise, you won’t gain weight, and you won’t do metabolic damage. Second, you can store it, in which case your insulin goes up, you gain weight, and you do some metabolic damage. Or third, the energy goes out in your urine, in which case you wreak complete metabolic havoc and cause kidney damage, as seen in poorly controlled diabetics who end up on dialysis.
more color means more antioxidants, and fruits and vegetables are packed with them.
Soy infant formulas are packed with these compounds, and consuming soy formula is a well-known contributor to weight gain. The formula Isomil is 10.3 percent sucrose (Coca-Cola is 10.5 percent sucrose). It’s a baby milkshake! Add to that the genistein in the soy formula, and put all that in a baby bottle containing bisphenol-A.
The addition of sugar to a food also adds humectancy, which is the ability to hold on to water. This is extremely important for preventing your favorite treats from going stale, particularly your baked goods.
One way to gauge the effect of sugar on humectancy is the staling of bread. How long does a loaf of bread purchased at your local bakery take to go stale? About two days. How long does a loaf of commercial bread purchased at the supermarket take to go stale?
The food industry removes fiber from food because fiber limits shelf life. Bread devoid of fiber is going to last far longer in your pantry than if you buy it fresh at the farmers’ market.
Let’s take a generic cookie as an example: 30 percent flour, 30 percent fat, 30 percent sugar, and about 6 percent protein. This is the ultimate concoction of fat and carbohydrate possible in one food item. And sweetness has more salience (appeal) when you add fat. (Which would you rather eat: Pixie Stix or a Cinnabon?) One cookie is a treat. But bet you can’t eat just one, because sugar is addictive, and sugar plus fat is even more so.
all successful diets share three precepts: low sugar, high fiber (which means high micronutrients), and fat and carbohydrate consumed together in the presence of an offsetting amount of fiber. Anything
The traditional Japanese diet is polished white rice (lots of carbohydrate), a little fish, some fermented soybeans, and lots of vegetables.
Even though it is high in carbs, the traditional Japanese diet works for four reasons: First, there is virtually no sugar to promote insulin resistance. Second, the insulin rise caused by the glucose in the rice is partially attenuated by the fiber in their vegetables. Third, the fish is high in omega-3s. Four, it’s high in micronutrients and antioxidants. A winning combination. Using fiber as the antidote to carbohydrate (see chapter 12) is the salvation of many a successful diet.
whole grains, fresh fruits, and vegetables
Here’s what’s in the real Mediterranean diet: high olive oil consumption (monounsaturated fat); legumes (beans, lentils, peas); fruits, vegetables, and unrefined grains (fiber); dairy products (saturated fat); eggs (high-quality protein); fish (omega-3s); and wine in moderation (resveratrol, flavonoids, and likely other factors).
The Ornish diet espouses that participants should not get more than 10 percent of their calories from fat. (A low-fat diet provides about 30 percent of calories as fat.) Here’s what’s allowed on the Ornish diet: beans and legumes, fruits, whole grains, and vegetables (in other words, all fiber all the time). Ornish allows nonfat dairy products in moderation. And here are the no-nos: meat of all kinds, poultry, oils and oil-containing products (e.g., salad dressings), nuts and seeds, sugar, and alcohol. In other words, the no-fun diet.
What do they all share? Two things. They are all low in sugar, and they are all high in fiber (and therefore high in micronutrients).
How do you navigate your supermarket? It’s a minefield. First Rule If you go to the market hungry, all is lost. Second Rule Shop on the periphery of the supermarket. If you go into the shelves, you’ve gone off the ranch. Third Rule Real food doesn’t have or need a Nutrition Facts label. The more labels you read, the more garbage you’re buying. Fourth Rule Real food spoils—which is a good thing. If bacteria can digest it, that means you can, too (since your mitochondria are just repurposed bacteria).
Fifth Rule Find the hidden sugar.
So how to curb your sugar consumption? Start with eliminating all sugared beverages. We were designed to eat our calories, not drink them.
Eat your fruit, don’t drink it.
Second, take all your recipes and wherever sugar is called for, reduce the amount by one third.
Lastly, make dessert special. When I grew up, dessert was once a week. Now it’s once a meal and also at snack time.
My children know that a weekday dessert means a piece of fruit, and weekends are reserved for something more elaborate.
what to look for on a Nutrition Facts label: If it’s a liquid, it should have 5 calories or less. (Unflavored milk is the only exception. Remember, milk sugar is lactose, which turns into glucose in the liver—no fructose here.) If it’s a solid, it should have 3 grams of fiber or more (See chapter 12). If the words partially hydrogenated (aka trans fat) appear anywhere, it’s been designed not to go rancid. So it may very well outlast you. If any form of sugar is one of the first three ingredients, it’s a dessert.
Yogurt. A 20-ounce Coca-Cola has 27 grams of “total sugars.” A standard 6-ounce Yoplait yogurt also has 27 grams of “total sugars.”
A Greek yogurt with no added sweeteners is 64 grams of total sugar per 24 ounces, or 16 grams per 6 ounces.
The goal of obesity management is to keep your insulin down. This is a sample shopping list, based on four principles, to accomplish this goal: 1. Low sugar 2. High fiber 3. Low omega-6 fats 4. Low trans fats Similar to the Traffic Light Diet, items listed as “green” can be eaten ad lib, those listed as “yellow” suggest mild caution (about three to five times per week), and those in “red” should be reserved for special occasions (about 1 to 2 times per week).
first rule is, stay out of fast food restaurants at all costs.
Second, don’t buy anything you can eat while standing up, because then you’re not thinking about your food, and you’re likely using your hands (which means more processed carbohydrates), not utensils. Sit down, enjoy it, make it a meal.
Third, make sure it has some sort of protein—anything from sliced turkey to natural peanut butter is okay, just don’t go for a baked good, which is just fat, carbohydrates, and sugar. Lastly, no smoothies or Frappuccinos™!
even when they rate a serving as too large, people will finish a larger portion merely because they’ve already paid for it.28 Even having eaten more than they wanted, customers still see these “extra-value” meals as a good deal.
The rules for dealing with restaurants are very simple. 1. If the food comes in a wrapper, the wrapper has more health benefits than the food. Fast food restaurants are the antithesis of real food. 2. Whatever you do, don’t order soda. 3. Ask the server not to put bread and chips on the table. 4. If you’ve already had dessert this week, don’t make this your second.
the dictionary definition of behavior is: “a stereotyped motor response to a physiological stimulus.”
Every human behavior requires hormonal signals for expression (sexual behavior: androgen, estrogen; parental behavior: oxytocin). These behaviors truly are innate; they are the product of our biochemistry, which has developed evolutionarily for our survival.
Get the Insulin Down: Eat Fiber, Reduce Sugar, Exercise
The best way to reduce insulin release is to limit the exposure of the pancreas to the agent that drives insulin up, which is glucose. This means cutting back on refined carbohydrates.
Another way to lower your insulin is to eat more fiber, which reduces flux to the liver and the insulin response (see chapter 12). Opt for brown foods: beans, lentils, whole grains, nuts, and other legumes. And eat the real stuff: the whole fruits and vegetables rather than their processed or juiced derivatives.
Finally, improving muscle insulin sensitivity is very simple—only exercise will do it, because once muscle fat is stored, the only way to get rid of it is to burn it
Get the Ghrelin Down: Eat Breakfast with Protein, Stop Nighttime Bingeing, and Sleep More
ghrelin, the hunger hormone
A high-protein load has been shown to reduce ghrelin more than a meal high in fat or carbohydrates,3 so you will burn more just sitting. Plus protein has a higher thermic effect, meaning it costs double the energy to metabolize protein versus carbohydrates. Plus protein doesn’t generate nearly as high an insulin response as do carbohydrates, and doesn’t lead to your blood glucose crashing down, which makes you hungry sooner. Bring on the bacon and eggs.
Eating after dinnertime is problematic for everyone, because any energy consumed that late will have no chance to be burned. It will find its way either to the fat tissue or to the liver, making the patient even more insulin resistant.
This means eating a sensible breakfast and lunch with no snacks added, and dinner must consistently occur a good four hours before bedtime.
Get the PYY Up: Eat Appropriate Portions, Wait Twenty Minutes for Seconds, Eat Fiber
Get the Cortisol Down: Exercise
Cortisol is your short-term friend and your long-term enemy.
excess cortisol drives visceral fat, insulin resistance, and further food intake, it’s the triple whammy for metabolic syndrome.
Although exercise raises your cortisol while you’re doing it (to mobilize glucose and free fatty acids for energy), it reduces your cortisol levels for the rest of the day. It burns off fat in your muscles to improve muscle insulin sensitivity, and in your liver to improve hepatic insulin sensitivity.
In our clinic, the rule is to buy your screen time with activity. Every hour of TV or computer games means an hour of playing sports.
menthol is frequently added to cigarettes. In 2011 the Tobacco Products Scientific Advisory Committee of the FDA showed that “menthol has cooling and anesthetic effects that reduce that harshness of cigarette smoke,” and that this effect “could facilitate initiation or early persistence of smoking by youth.”
Michael Pollan succinctly put it, “If you’ve got one dollar to spend on food, are you going to buy 1200 calories in potato chips or 200 calories in carrots?”