According to a recent report from the United Nations Food and Agricultural Organization, the United States has the highest obesity rate of all developed nations. Standing at 38.2%, the US is followed mostly closely by Mexico at 32.4%.
While some blame the problem of obesity in the United States on the prevalence of its fast-food culture and inactive lifestyles, from TCM’s point of view it is not difficult to see why Americans may be more prone to obesity than people in other countries. It is interesting to note that of the top 30 most obese countries, none is in the East Asian cultural sphere that includes China, Korea, Taiwan, Japan, Vietnam, Mongolia, Malaysia and Singapore. This is not because people in those countries have particularly active lifestyles or do not share the Americans’ love of fast-food, but rather that there are certain health and other cultural practices that make them less prone to obesity.
Table 5.1: Percentage of population over 15 years who were obese in 2015 (Obesity Update, OECD 2017)
Before we try to understand how it is some cultures rather than others can lead to obesity, let us first discuss the causes of obesity from TCM’s point of view.
The relationship between obesity and heart disease is well known and accepted by the general public. However, in terms of cause and effect, TCM’s and Western medicine’s views on this subject are completely different. Western medicine believes that people who are obese have an increased risk of heart disease. In other words, being overweight is a likely cause of heart disease. TCM’s point of view on this relationship is the reverse: people who have heart disease are more likely to develop obesity. In other words, heart disease is the cause of obesity.
The reason for the difference of opinion lies in the diagnosis of heart disease or, more specifically, the time period for the diagnosis. Pulse diagnosis is one of the most common diagnostic techniques used in TCM. Using pulse diagnosis, skilled TCM doctors are able to detect heart abnormalities much earlier than by using methods employed by modern medicine. This isn’t to say that pulse diagnosis is more accurate or more reliable than modern instruments such as an electrocardiogram (ECG) or echocardiogram (Echo), but it is a much more common practice during TCM’s diagnostic procedure, so the signs of heart problems are likely to be detected much earlier. Pulse diagnosis is, for example, extremely effective in detecting a condition called pericardial effusion (fluid around the heart). It can often detect this in patients even before they experience symptoms associated with it, such as shortness of breath and palpitations. The main diagnostic method in modern medicine is by physical examination, in which the doctor listens for abnormal sounds from the heart. Unless the patient has significant symptoms of pericardial effusion, the problem is rarely detected unless he or she undergoes ECG or Echo procedures. This difference in diagnostic sensitivity extends to various other heart diseases. To confirm, as a good TCM doctor is able to detect heart abnormalities before the symptoms become detectable by the patient, TCM is likely to diagnose a patient with heart problems much earlier than Western medicine does in practice.
With that in mind, let us go back to the relationship between obesity and heart disease. Because of early heart disease detection, TCM is able to observe patients with the early stages of heart disease. Obesity is often an outcome for these patients, therefore TCM is able to conclude that there is a relationship between obesity and heart disease. Since obesity generally happens much later than heart disease, it seems to be the result rather than the cause. Conversely, because modern medicine detects heart disease during its later stages, when the symptoms are already apparent and obesity already present, obesity is seen as the cause rather than the result.
To understand the relationship better, we first need to understand the difference between what TCM and modern medicine view as the cause of obesity. Modern medicine views obesity as simply a lack of energy balance, meaning energy in is not equal to energy out. Energy in is the amount of energy or calories you get from food and drinks, and energy out is the amount of energy that your body spends on body functions and activities such as breathing, digesting, sports etc. If a person’s energy in is more than their energy out, then they will gain weight when the left over energy is stored as fat. While TCM agrees that people will gain weight if they consume more calories than they use, it asserts that the biggest factor in obesity is how efficiently a person’s body is able to use energy and excrete waste. TCM suggests that several factors can influence how efficiently the person’s body is able to burn off excess energy and excrete waste. As obesity occurs when the body loses its ability to perform such tasks, TCM’s treatment focuses mainly on improving and restoring the body’s ability to burn off calories and remove waste.
In the next sections I will go into detail on how TCM treats obesity. The treatment can be divided into two parts: improving the efficiency of the heart and spleen and improving the fluidity of the meridians.
Poorly functioning heart and spleen systems are the main cause of obesity
TCM views the heart as the most important organ in the human body. Of the five major internal organs, or the five Zangs (heart, liver, spleen, lungs, kidneys), the heart is the foremost. Its importance lies in its ability to pump the blood that directly impacts upon the functionality of the four other major organs.
According to TCM theory, the spleen system plays an important part in two major body functions: the transport of body fluid and the functioning of the immune system. The transport of body fluid is crucial during our body’s waste removal process. A spleen system that is overworked or malfunctioning will cause a delay in the body’s waste removal process. Over time, that delay will cause excess waste to remain throughout the body, leading to excess fat. An overworked spleen system occurs when a person’s immune system is consistently being overstressed. The immune system can become overstressed when the person has lengthy bouts of internal infections. A typical infection comes from unclean food or drink. Raw foods, especially raw fish or beef, often contain parasites. Frequent ingestion of such foods will lead to frequent parasitic infections in the digestive system, which may result in an overstressed immune system. In women, chronic gynecological infections and poor postpartum care may also lead to a poor spleen system due to constant bouts of infections.
The functionality of the spleen system will affect the functionality of the heart system via the pericardium. The pericardium is a double-walled sac that surrounds and covers the heart. Between the pericardium and the heart is pericardial fluid, which acts as cushioning as well as lubrication for the heart so that it can move freely within the pericardium. When the spleen system is overworked due to infection or low body energy, the spleen system’s ability to transport water declines, which then leads to an increase in the pericardial fluid. An excess of pericardial fluid will limit the flexibility of the pericardium, which will reduce the heart’s ability to pump blood. As the heart’s ability declines, there is a negative effect on the functionality of the four other main organs; this becomes a vicious cycle as the decline of the heart will further decrease the spleen’s ability to transport water, which will then cause an increase in the pericardial fluid, and the cycle will lead back to the decline in heart function.
As the condition continues to worsen, the person will become more and more obese as the body is unable to remove waste water efficiently. As heart function continues to decline, the person will eventually experience noticeable heart-related symptoms, such as irregular heartbeat or palpitations, as well as high blood pressure. If the person then visits a doctor and undergoes heart examination, it is likely that a variety of heart diseases will be diagnosed. While it appears that the heart disease may be due to obesity, when we follow TCM theory it is easy to see that the person’s heart problems actually began prior to becoming obese.
Activities or habits that may contribute to spleen weakness
Now that I’ve explained how the decline of spleen and heart functioning contributes to obesity, let us examine the various daily activities and living habits that may cause this decline.
Unclean diet
Some of the most common infections occur in our digestive system, caused by the foods we eat as well as the methods that we use to eat them. Given that people generally develop dietary habits that do not readily change, these infections may become a chronic problem, as someone who practises poor dietary habits will experience repeat infections.
The most common form of infection comes from eating raw foods, particularly raw meats or fish. Parasites are a common and natural occurrence in fish. When eating raw or undercooked fish, the risk is high that a person will contract parasitic diseases. While certain preventive measures are taken in the preparation of raw fish dishes such as sushi and sashimi, these dishes still carry a much higher risk of containing parasites when compared with cooked fish. In order to completely eliminate parasites, the fish must be frozen at a temperature of -20ºC for at least seven days. Since most kitchens do not have the proper equipment to reach such temperatures, eating raw fish will likely come with the risk of infection. Similar infections also occur in the consumption of undercooked pork, poultry, beef and other meats.
It is important to remember that while the symptoms of these infections may not always be noticeable, if a person ingests pathogens by consuming raw foods, the body’s immune system will always be working to defeat them. To put it simply, one may not always notice the consequences of ingesting unclean foods, but the damage done to the body by such food will still occur. When a person’s body defends itself against these pathogens, the spleen system will become overworked, leading to the vicious cycle described earlier (see page 52).
Besides eating raw foods, infection via saliva is another common problem. Adult mouths may contain between 500 and 1000 different types of bacteria. The particular combination found in any one person will be unique. In other words, it is unlikely that two human beings will have exactly the same oral ecology. In instances where saliva is exchanged, cross-contamination between different oral ecologies can cause infection. This form of cross-infection commonly occurs during group dining where eating utensils are shared, or in Chinese dining where chopsticks are used. In traditional Chinese dining, food dishes are shared amongst all the people at the table and each person uses their chopsticks to transfer food from the main dish to their plate or bowl. Each person then uses the same chopsticks to consume food on their plate.
Infection via saliva is particularly harmful to children, especially young infants, who have far fewer bacteria in their mouths than adults; a sudden cross-contamination of saliva between adult and child can be much more damaging for the child. Thus it is recommended that children have separate eating utensils and parents are encouraged to avoid any unnecessary exchange of saliva with their children.
Gynecological infections
In women, a common cause of stress to the spleen system may come from reccurring gynecological infections, specifically infections of the vagina, cervix and uterus. Because these can occur repeatedly, women who suffer from these ailments will also suffer from the overstressing of their spleen system. It is difficult to prevent such infections. Besides the obvious method of practising good feminine hygiene, having a healthy lifestyle (sleeping early, proper diet) will help to increase body energy and improve the immune system so that the body can better defend itself and recover from those infections.
Postpartum recovery care
The methods of care used in the postpartum (after giving birth) period differ greatly between Western and Chinese cultures. In the former, not enough emphasis is placed on postpartum care compared with Chinese societies. When we use TCM theories to examine the effect of a lack of postpartum care, it is easy to see some of the long-term damage this can do to a woman and how the damage can lead to obesity.
Giving birth takes a heavy toll on a woman’s body. Whether the method is a natural vaginal delivery or a Caesarean section, a significant amount of haemorrhaging and scarring is expected during and after childbirth. Thus it is important for a woman to take care of her body at this time so that it has sufficient time and a supportive environment in which to recuperate. During this period, it is natural for the spleen system to be under constant stress because the body must heal the wound(s) that it sustained during delivery. Therefore it is recommended that the woman should increase rest as well as adjust her diet and lifestyle in order to minimise stress. Failing to do so may cause long-term damage to the spleen system as well as to the kidney system. Both these systems are important in the body’s waste removal process. As described earlier, the spleen system governs the transportation of the body fluid that carries the body’s waste material. The kidneys govern the final stage of the waste removal process – that is, the excretion of the waste product through urination. Thus damage done to either one of these two systems will cause a disturbance in the body’s waste removal process, which can lead to obesity. Such damage may not be apparent at the outset, but the symptoms will begin to show as the woman approaches menopause. In other words, TCM believes that women who did not receive proper postpartum care are more likely to gain weight after menopause, because of the damage that was done to their spleen and kidney systems during the postpartum period, which has reduced their body’s waste removal function.
In Chinese cultures, women typically rest for 30 days after giving birth. During that period there are specific rules governing diet and living conditions that the postpartum woman must follow to ensure proper recovery. The details of Chinese postpartum care are too specific for this book and widely available online. I suggest all my readers take the time to research these methods as they are generally effective.
Drinking iced water as a cause of obesity
The relationship between iced water and obesity is a difficult one to understand and accept, especially without any prior knowledge of Traditional Chinese Medicine. In my experience of conveying this concept to people, the first reaction has generally been that such a thing is impossible. Water, as we know, contains no calories, thus it is impossible to become obese from drinking water. While I agree that the water itself does not cause obesity, the process of drinking iced water may do so.
As discussed earlier, the proper functioning of the heart and spleen systems is essential in the body’s waste removal process. A disturbance in either system will have a negative impact, resulting in obesity. Drinking iced water or, more specifically, drinking iced water under particular circumstances, may cause significant damage to the heart system.
Having an ice-cold glass of water when the outdoor temperature is high, or directly after exhausting exercise, is a common practice for many people. Most people enjoy the experience because drinking cold water in high temperature helps the body to cool down at an accelerated pace. What people do not realise is that this activity carries the hidden danger of damaging the heart. To understand how that occurs, we need first to understand how our body deals with heat.
The human body can function only within a specific range of body temperatures. When the body temperature rises above the acceptable range, it can cause body proteins and cell membranes to be damaged or destroyed, which will then lead to severe symptoms and death. The body prevents itself from overheating by using two methods to cool down, both of which rely heavily on the heart.
The first method of cooling is radiation. Heat behaves like water flowing downhill. As long as the air temperature surrounding the body is lower than the body temperature, heat will radiate from the body to the air. However, the transfer of heat slows down or stops as the gap between air temperature and body temperature narrows. This radiation mechanism requires the circulatory system to reroute blood flow so that more blood travels to the skin. The second method of cooling is through sweat evaporation. Every droplet of sweat that evaporates from the skin will carry away heat from the body. However, besides removing heat, sweat also carries sodium, potassium and other essential minerals away from the body, which may cause a chemical imbalance. To counter these losses, the heart must pump faster and harder as the body secretes hormones to help the body hold on to water and minerals.
The heart is central to the body’s cooling process, relying heavily on the effectiveness of that process to maintain temperature and avoid overheating. A person drinking iced water immediately after exhausting exercise causes a major disturbance to the body’s cooling process. As the iced water enters the mouth, the cold sensation that is felt in the mouth confuses the brain into believing that the body has cooled down and no longer requires as much cooling as it actually does. The result is that the body will prematurely terminate the cooling process, believing that it has already cooled off. This disturbance causes damage to the heart because the heart itself is unable to receive sufficient cooling.
Chew your food
In today’s world, obesity is a major issue for many countries, as shown in Table 5.1. The main focus is on the diet of the individual and his or her exercise regimen, and very little has been said about how styles of eating relate to obesity. The term ‘healthy eating’ rarely refers to the method and speed of food consumption. In my opinion, while choosing the right food is important in building a healthy diet, eating slowly and chewing your food properly are no less important.
The human body requires key nutrients that are derived from the foods we eat. However, simply eating is not enough. The rate of nutrient absorption determines the efficiency of our eating process. In a hypothetical scenario where two people with a similar body type have the same diet, the person with a higher nutrient absorption rate will be able to acquire key nutrients from a smaller amount of food. In the long run, the amount of food we eat and the type of food our body craves will be relative to our body’s ability to acquire the essential nutrients. So increasing our body’s nutrient absorption rate should be one of the main steps toward developing a healthy diet.
How properly chewing your food increases nutrient absorption
Our body’s absorption of nutrients mostly occurs when the food reaches the small intestine. Foods that are not properly digested will not be able to pass through the wall of the small intestine and will instead exit the body as waste.
The action of chewing food plays an important part in determining whether food is properly digested. Firstly, if a food particle is too large when it reaches the small intestine, it will not be able to pass through the intestinal wall. By chewing food properly we ensure that it can be fully broken down in the stomach. Secondly, chewing food ensures sufficient secretion of bile, which is essential in the digestion of fats.
Bile is produced continuously by the liver and stored and concentrated in the gallbladder; from there it is discharged into the duodenum after food has been ingested. The effectiveness of the gallbladder is related to the fluidity of the gallbladder meridian. A person whose gallbladder meridian is congested will have trouble with bile secretion. When we examine the gallbladder meridian, we will notice that a major portion travels across the cheek area. During the process of chewing food, our facial muscles will naturally massage the gallbladder meridian in that area, which will make it more fluid. So by chewing our food properly, we can ensure that our bile secretion is sufficient.
I recommend chewing each bite of food at least 20 times before swallowing. If we can develop this habit, we will be certain of properly digesting food both physically (breaking food down into smaller pieces) and chemically (prompting sufficient bile secretion to dissolve fats). Proper digestion increases our nutrient absorption rate, as a higher percentage of food can be absorbed through the wall of the small intestine. When the body can absorb sufficient nutrients even when the amount of food it ingests decreases, controlling calorie intake becomes easier as our appetite naturally becomes smaller. The practice of chewing food properly should be the foundation of any weight-loss programme.
Now it is time to introduce you to the massage programme for promoting meridian fluidity that I have mentioned earlier.
