Chapter 2

Epic Tale or Epic Fail?

So, what’s going on? Why are so many people overweight? Why are so many people sick?

Let me start by saying, that although the answers are definitely - diet and life style related, we are not overweight or sick because we somehow failed as individuals. The problem has nothing to do with self-indulgence, willpower, or laziness. Nobody I know wants to be overweight or sick. No parent would choose that for their kids either. The real answers are complicated. I will try to break them down for you as best as I can.

The First Law, the First Problem

The first problem is one we have had for a long time. It’s in how we’ve come to view weight gain, and weight loss in the first place.

When I studied for my certifications to become a Personal Trainer, Weight Management Specialist, and Physique and Figure Training Specialist, I was taught that we gain weight because we eat too much and move to little. The course work illustrated among other things, that because of our busy lifestyles, people today often had no time to cook at home. This in turn, caused people to eat too much junk food and fast food. It also described how our technology filled lives, had left us sedentary. I was taught, that to help people lose weight and be healthier, I would have to educate them on how to eat less, make better food choices, and exercise more. Basically, it was up to me as a trainer and coach to set them straight. I must admit for a while I bought the whole argument. It supported everything I’d learned over the years. This was an accredited school with a great reputation, they must know what they were talking about, right?

Robert H. Lustig, M.D. is a Neuroendocrinologist. He also serves as Professor of Pediatrics in the Division of Endocrinology at University of California, San Francisco, and the Director of the Weight Assessment for Teen and Child Health (WATCH) Program at UCSF. In his 2013 book, Fat Chance, he wrote, “To blame obesity on the obese is the easy answer, but it is the wrong answer. The current formulation of gluttony and sloth, diet and exercise, while accepted by virtually everyone, is based on faulty premises and myths that have taken hold in the world’s consciousness.”

My educators had based their literature and teachings, on this same formulation of gluttony and sloth, diet, and exercise. These concepts are so generally accepted; doctors and health organizations alike have been basing their recommendations on them for years. For example, the American cancer society has a chart on their web page which is titled, Make Exercise Work for You, which illustrates you how much exercise you’d have to do to work off a large order of fries, (see figure 1),

To burn off a large order of fries (400 calories)

A 160-pound person could burn off 400 calories in the time and activities shown below:

 

Activity	Minutes
Moderate walking	95
Scrubbing Floors	89
Dancing	70
Bicycling	39
Running	28

(Figure 1)

 

And according to a January 2016, on line article by The American Heart Association, you should follow the following advice,

» “If you are trying not to gain weight, don’t eat more calories than you know you can burn up every day.”

» “Increase the amount and intensity of your physical activity to match the number of calories you take in.”

» “Aim for at least 150 minutes of moderate physical activity or 75 minutes of vigorous physical activity – or an equal combination of both – each week.”

These pervasive, yet incorrect, concepts all hinge on something in physics called the first law of thermodynamics.

The first law of thermodynamics states, that the total energy of an isolated system is constant; energy can be transformed from one form to another, but cannot be created or destroyed. In other words, the body can neither, create nor destroy energy. It can only transfer energy from one state to another. So, when you take in energy in the form of food, it must be transferred to the muscles, organs, and tissues, where it will be used as energy. Excess energy will be stored as fat.

Based on this interpretation, if you expend more energy than you take in you will lose weight. No matter what you eat, if you consume less calories than you expend, you will burn fat and lose weight. While this all sounds very reasonable, it’s an over simplification of the process.

Food is More Than Sustenance

Let’s begin our discussion by dispelling the notion that all calories are created equal. Everything we eat is processed by our bodies, but not everything we eat is processed in the same way.

Dr. Mark Hyman serves as chairman of the board for the Institute for Functional Medicine. He founded both The UltraWellness Center (located in Lenox, MA) and The Cleveland Clinic Center for Functional Medicine, which is located in Cleveland, OH.

In his book “Eat Fat, Get Thin”, Dr. Hyman explains how our weight is affected by the types of foods we eat, and the biological responses those foods trigger. He wrote, “This hormonal or metabolic hypothesis of weight gain supports the idea that it is the composition and quality of the foods you eat (and the hormones and biochemistry they subsequently trigger) that determine whether you lose or gain weight. In other words, it is not how much you eat but what you eat that controls the metabolic switches. Foods inherent information-the messages and instructions it contains is what drives your metabolism”

What does that mean? It means that different foods interact with our systems in distinct ways. Food is more than sustenance. The quality of the foods we eat have a huge impact on our bodies and our health!

Foods are categorized into the following three macronutrients: carbohydrates, fats, and protein. These are then broken down even further within their categories, for example: carbohydrates can be starches, sugars, or fiber. Fats can be saturated, unsaturated, and mono-unsaturated. Proteins are either complete (containing all 22 amino acids), or incomplete. Essential (can’t be synthesized by the body), non-essential, or conditional (needed in times of illness and stress).

Any food that is not a fat or a protein is a carbohydrate. Carbohydrates are not essential nutrients. There is no daily required amount of carbs. Refined carbohydrates tend to go through the digestion process very quickly, spiking our blood sugar levels and causing our bodies to respond by releasing insulin into the blood. Too much insulin in our blood can cause a number of difficulties for us.

Without insulin, there is no fat storage. Normally when we eat, some insulin is secreted by the pancreas into the blood. As we digest, some of the energy from our food is used by the body, and some of it is stored as fat. When things are functioning correctly, the food energy that is stored as fat is only stored temporarily. Once the meal has been completely digested and there is no more glucose in the blood, the energy which was temporarily stored as fat, is released from the fat cells back into the blood stream for use.

Problems can occur when we eat too many carbohydrates, especially refined carbs, and sugars which cause large sugar and insulin spikes in our blood. When there is too much insulin in our blood almost all the energy from the food gets pushed into our fat cells for storage, and is locked there. Very little energy is made available to the body for usage. When the food is completely digested, none of the energy which was stored as fat is released back into the blood for use, causing a sugar crash. This lack of available energy in the blood, tells our brain that we are starving. The body responds to this starvation emergency in two ways, by slowing down our energy expenditure, and by producing hormones which signal hunger. This hunger drives our cravings for the quickest form of available energy, which is carbohydrates. This becomes a vicious cycle. The more carbs we eat, the hungrier we become. The hungrier we become, the more carbs we eat. Meanwhile insulin continues to push all the energy from our food into our fat cells making us fatter and fatter. This eventually puts our overly full fat cells into distress and they become inflamed. When our fat cells become inflamed they release proteins called cytokines into the blood. The presence of cytokines in the blood causes systemic low grade inflammation. Chronic inflammation of this nature has been associated with Alzheimer’s, hypertension, heart disease, insulin resistance, diabetes, and other chronic illnesses. Too many insulin spikes over time can also lead to insulin resistance. Insulin resistance is a state in which the body becomes insensitive to, or unresponsive to insulin. In a state of insulin resistance, more and more insulin is needed to handle the sugar in our blood. When the pancreas can no longer produce enough insulin to handle the sugar in our blood, it is called diabetes. Developing Type 2 diabetes is akin to developing an intolerance to carbohydrates.

Diabetes is somewhat of a doorway disease because having diabetes opens the door to increased risk of heart disease, vascular disease, kidney disease, vision loss and amputations. Recently a study on diabetes was published in The Lancet. The study evaluated the impact of diabetes on a global scale. Researchers examined data collected from 200 countries, over the last 35 years. They found that diabetes and its complications account for more than 2 million deaths every year, and are the seventh leading causes of disability worldwide. Additionally, the Global cost of diabetes is now 825 billion dollars per year!

Diabetes has been prevalent in my family, particularly on my mother’s side for generations, leading as far back as my great grandparents, and possibly further. I equate this to culture, genetics, and hardship. When I was a kid, my grandmother was famous for her red rice with peas, her fideos (a pasta dish), and her pot roast with potatoes. I remember my dad used to tease her about being the only person he knew who would serve rice, potatoes, pasta, and bread all in the same meal. Nanny would laugh and say it was the only way to stretch the meal, especially, back when my dad was dating my mother, because he could eat so much, and she and Poppy, could only afford to buy a little meat. I remember many weekends when she brought rice and potatoes to our house to share at family dinners. I’m certain that rice, potatoes, and bread, which have always been a lot cheaper than meat, were staples at my grandmother’s table. My grandparents lived during tough economic times. My grandfather worked for a factory unloading trucks for a living. They raised three children, and helped care for extended family on my grandfather’s modest salary. I believe they ate the way they did out of necessity, and because eating habits are learned from your family. Recipes and traditions are passed down through the generations.

Insulin resistance which leads to diabetes, can also cause other problems. When we need energy, a hormone called ghrelin is secreted. Ghrelin is the hunger hormone. It signals us to eat. When we’ve eaten enough, a hormone called leptin is secreted. Leptin is the satiety hormone. It signals us to stop eating. When the cycle is complete, we literally have energy to burn. However, when there is too much insulin in the blood, the insulin can block the leptin signal from getting to the brain. When this happens the person, who is insulin resistant, is now also leptin resistant. Even when the stomach is full the brain never gets the message to stop eating. A person who is leptin resistant can feel hungry all the time. The only effective way to reduce leptin resistance is by lowering the amount of insulin in the blood. To reduce the amount of insulin in the blood, you must avoid carbohydrates. Especially refined carbohydrates and sugar.

Sugar is a source of dangerous inflammation which has been linked to many chronic diseases like Alzheimer’s, diabetes, hypertension, and cancer. Numerous studies have sited a correlation between Alzheimer’s disease and diabetes.

In a 2016 article, published in the Journal of Alzheimer’s Disease, New York University professor Melissa A. Schilling wrote, regarding her own investigations, “The results suggest that avoiding excess insulin, and supporting robust IDE levels, could be important ways of preventing and lessening the impact of AD.” (IDE refers to insulin-degrading enzyme, an enzyme which is secreted by cells to mitigate insulin in the blood)

In a study, which was published in 2002 in the Journal of the National Cancer Institute, researchers sought to investigate the relationship between high glycemic diets, post meal blood sugar spikes, and pancreatic cancer. It was a continuation of the famous 1976 Nurses’ Health Study, a study which originally followed 121,700 nurses to research the potential long-term consequences of oral contraceptives. The new research studied 88,802 of the original participants from 1980-1984. Researchers expressed that insulin and insulin resistance may play a role in promoting pancreatic cancer. They concluded that although statistics did not support an overall association between dietary glycemic load and pancreatic cancer, there was a statistically significant influence of glycemic load on pancreatic cancer risk among overweight and sedentary individuals, and that this data supported the hypothesis that, “abnormal glucose metabolism and states of relative hyperinsulinemia enhance pancreatic carcinogenesis.” In other words, being diabetic and having too much insulin in the blood increases the risks for pancreatic cancer.

In 2006, another large study was done and published, in the American Journal of Nutrition. This study examined the association of added sugar and of high-sugar foods with the risk of pancreatic cancer. The study followed 77,797 men and women for eight years. Data collected during this study supported researcher’s hypothesis that a high consumption of sugar and sweetened foods may be associated with the risk of pancreatic cancer.

In July of 2009, Dr. Robert Lustig, in conjunction with the University of California presented, Sugar the Bitter Truth. It was a video presentation filmed as part of a series called, Mini Medical School for the Public. In his presentation, Dr. Lustig demonstrated how sugar, especially fructose (the kind of sugar found in high fructose corn syrup), is processed through our livers in exactly the same manner as alcohol. This is significant because it means that eating too much sugar can cause as much damage to your liver, as drinking too much alcohol.

Let me explain how it happens. Sugar is composed of glucose and fructose. Fructose and alcohol are both processed by the liver. If you think about it, alcohol is just sugar that’s been fermented. The liver uses fructose to create fat. Given enough fructose, fat begins to accumulate in the liver. A buildup of fat in the liver causes a condition known as called Non-alcoholic fatty liver disease (NAFLD). 1 in 3 adults, and 1 in 10 children in America have NAFLD. Non-alcoholic fatty liver disease can become Non-alcoholic steatohepatitis (NASH).

NASH, is a very similar condition to alcoholic liver disease. In NASH, there is an accumulation of excess fat, inflammation, damage, and scarring, in the liver of people who drink little or no alcohol. NASH is often called silent liver disease, because it has almost no symptoms. The people who are affected by it often feel well, and are unaware that there’s even a problem. NASH is very serious and can lead to cirrhosis of the liver. Astonishingly, you don’t have to be a drinker to develop cirrhosis of the liver.

As reported by an article in the August 25, 2016 issue of the New England Journal of Medicine, cirrhosis is the 8th leading cause of death in the USA and the 13th leading cause of death globally, representing a 45.6% increase worldwide since 1990.

Due to the increasing prevalence of NAFLD, cirrhosis related to NASH is predicted to become the most common reason for orthotopic liver transplantation in the USA. Diagnosis often occurs after a liver enzyme test comes back a little elevated, but NAFLD can be present even with a normal liver blood test result. The best way to screen for NAFLD is with an ultrasound of the liver.

Think back to my mother-in-law Selma. She has Cirrhosis of the liver, yet she has never been much of a drinker. She has however, always loved her sweets. Jelly doughnuts and gooey ice cream sundaes with caramel sauce, have always been her favorites.

But even with her sweet tooth, Selma’s daily dietary habits have pretty much been the same as the typical American diet. For breakfast, most days she’d have orange juice, coffee with sugar, white toast, and her favorite hot cereal (a package of instant maple & brown sugar oatmeal). On days when she was running late to work, she’d sometimes grab a breakfast sandwich at Mc Donald’s. Lunches needed to be portable for work and often consisted of a juice box, a sandwich on white bread, a couple of low fat cookies, and a piece of fruit. A low-fat cereal bar, or a piece of white bread with a tiny smear of butter, would tide her over until dinner. Sweetened ice tea or soda were routinely served with dinner. Most nights there would be a few low-fat cookies, a thin slice of packaged cake, or a small piece of pie for dessert. As many of us do, she sometimes indulged in her favorite treats on the weekends, and she enjoyed some extra goodies around the holidays, and on birthdays.

Selma has been very careful over the years to maintain a healthy weight, and has always remained slim. In truth, she takes pride in having healthy habits. She has always been great about going for regular checkups, and health screenings, and she has diligently followed all the low fat and low cholesterol dietary recommendations made to her by both the USDA, and her personal physician. Could Selma’s non-alcoholic cirrhosis be related to years of sugar consumption, refined carbohydrates, and processed foods which are notoriously loaded with high fructose corn syrup? There is strong scientific evidence which leads me to say yes.

While there is no daily requirement for carbohydrates, your body does require the nutrients found in fresh fruits, vegetables, and dark leafy greens. These unrefined types of carbohydrate foods contain phytonutrients, fiber, vitamins, and minerals which are needed by our bodies for function and health. We want to have an abundance of these incorporated into our daily dietary plan.

Phytonutrients and antioxidants, help prevent cancer by protecting our cells from the damaging effects of free radicals and oxidation. They can be found in colorful fruits and vegetables like: beets, dark leafy greens, blue berries, carrots, cherries, and tomatoes. Coffee, tea, red wine, and dark chocolate, also contain powerful antioxidants.

Foods like: apples, raspberries, asparagus, broccoli, and beans, are all high in fiber, which is an important dietary component. Fiber helps us to feel full, stay regular, and promotes good colon health. Fiber is also a favorite food of the beneficial bacteria which live in our intestines and help regulate our bodies. Fresh fruits and vegetables are also filled with essential vitamins and minerals needed for all sorts of biological processes like, cell growth, blood clotting, and energy.

Essential fatty acids (EFAs) are needed for optimal health but they can’t be synthesized by the body, so they must be obtained through diet. Healthy fats like omega 3’s and omega 9’s are found in nuts, fatty fish, avocados, and olive oil. These fats promote healthy skin, hair, and nails. Additionally, they are anti-inflammatory, and help support vascular, heart, and brain health.

It’s important to note, that nearly 60% of your brain is made up of fat. Fatty acids are critical to the brains function and integrity. In fact, studies have shown that eating a diet which is higher in fat can dramatically reduce the risks for dementia and Alzheimer’s disease, while an imbalance in the dietary intake of fatty acids has been associated with impaired brain performance and disease.

Interestingly, while high sugar consumption has been associated with lower testosterone levels in men, eating a diet that is high in healthy fats, has been found to increase testosterone levels.

Fats help us feel full sooner than other foods, and they speed up our metabolism. Fats are more readily used for energy, and are less likely to be stored as fat in the body because, dietary fats have little to no effect on insulin secretion. Remember, without Insulin there is no fat storage.

As with carbohydrates, not all fats are created equally. While omega 3 and omega 9 fats are healthy and anti-inflammatory, eating certain refined oils and too many omega 6 fats, can cause unhealthy, dangerous inflammation. Certain oils should be avoided altogether these include: trans fats, hydrogenated oils, and refined oils. Vegetable oils like: soy, corn, canola, cotton seed, sunflower and safflower, are all refined oils. Refined oils have been treated with high temperatures, and caustic chemicals which make them an unhealthy option. Additionally, the over use of these inexpensive, refined oils by the food industry, has injected our diets with too many omega 6 fats.

Most omega 6 fats cause inflammation. Even so, a certain amount of omega 6’s are needed for good health, and not all omega 6 fats are harmful. The ideal ratio is 1-1. In the common western diet however, the ratio is closer to 16 to 1, with the amount of Omega 3’s being severely deficient. This imbalance promotes the pathogenesis of many diseases including: cardiovascular disease, cancer, inflammatory disease, and autoimmune diseases. Increased amounts of omega 3’s with decreased amounts omega 6’s (lower omega 6/ omega 3 ratios) have been proven to suppress these kinds of illnesses. As stated in a 2008 article, by Artemis Simopoulos, the founder and president of the Center for Genetics, Nutrition, and Health, “In the secondary prevention of cardiovascular disease, a ratio of 4/1 was associated with a 70% decrease in total mortality. A ratio of 2.5/1 reduced rectal cell proliferation in patients with colorectal cancer, whereas a ratio of 4/1 with the same amount of omega-3 PUFA had no effect. The lower omega-6/omega-3 ratio in women with breast cancer was associated with decreased risk. A ratio of 2-3/1 suppressed inflammation in patients with rheumatoid arthritis, and a ratio of 5/1 had a beneficial effect on patients with asthma, whereas a ratio of 10/1 had adverse consequences. These studies indicate that the optimal ratio may vary with the disease under consideration. This is consistent with the fact that chronic diseases are multigenic and multifactorial.”

The bottom line is, a lower ratio of omega 6/omega 3 fatty acids reduces the risk for many of the chronic diseases which are prevalent today.

Proteins are found in every cell of the body. They’re required for structure, function, and the regulation of tissues and organs. The body uses protein to make enzymes, hormones, and other body chemicals. Protein is an important building block of bones, muscles, cartilage, skin, and blood. The body does not store protein, and therefore has no reservoir to draw on when it needs a new supply. Therefore, having the right amount of quality proteins in your diet is so important. Depending on age and activity level, 10-35% of a person’s diet should consist of protein.

High protein diets, where protein makes up more than 35% of the dietary intake, have been associated with: nausea, diarrhea, and hyperinsulinemia, a condition in which there are excess levels of insulin circulating in the blood relative to the level of glucose. Hyperinsulinemia is one of the symptoms of pre-diabetes which leads to insulin resistance. There are also concerns that, eating too much protein may cause a buildup of urea nitrogen in the blood exceeding the livers ability to process it. Evidence also suggests a relationship between high-protein intake, prostate cancer, and renal cell cancer.

A diet which is high in refined carbohydrates, refined oils, sugar, and red meat is an inflammatory diet, which can lead to chronic inflammation in the body. Dietary items such as garlic, dark leafy greens, olive oil, and turmeric are all anti-inflammatory foods, which reduce inflammation. (See figure 2 for a more comprehensive list.) Chronic Inflammation is not only associated with chronic diseases; it has also been linked to certain cancers.

 

Inflammatory foods	Anti-inflammatory foods
Trans fats	Berries
White Bread	Nuts & Seeds
White Rice	Whole Grains
French Fries and Fried Foods	Dark Leafy Greens
Soda	Mushrooms
Sugar and Corn syrup	Hot and Sweet Peppers
Omega 6 Fatty Acids	Omega 3 Fatty Acids
Mono sodium glutamate (MSG)	Tomatoes
Gluten	Beets
Dairy	Carrots, Parsnips & Turnips
Alcohol	Zucchini and Cucumbers
	Tart Cherries
	Black Pepper
	Ginger & Turmeric
	Garlic & Onions
	Cocoa & Dark Chocolate
	Basil, Rosemary, dill, Thyme & other Herbs
	Cruciferous Vegetables
	Avocado

(Figure 2)

I would like to tell you a little bit more about my father-in-law Ike. Sadly, he passed away over 25 years ago, at the young age of 61 from colon cancer. Ike was a wonderful man. He worked as a bell captain and concierge for a fine hotel in Manhattan. His job kept him busy, and could be very stressful at times. He was friendly, outgoing, and he loved to play golf with his friends on his days off. He was handsome, slim, and full of energy. He had a great sense of humor, and he was surprisingly generous. Ike would have given you the shirt from his back if he thought you were in need. His generosity was only surprising, if you knew that he had been born just a few short months before the beginning of the Great Depression, into a family where he was just one out of fourteen other children. Growing up he never had much, and probably had to share quite a bit. These were very hard times, and it’s likely that Ike wasn’t exposed to very many fresh fruits or vegetables as he grew up.

When he became a man his adult tastes, through no fault of his own, were limited by the scarcity he’d experienced in his childhood. He wasn’t accustomed to foods that had many spices in them, and so he liked his food to remain fairly plain. He only ate a small variety of vegetables, which included: corn, peas & carrots, cucumber, canned green beans, and tomatoes. He never ate things like: Brussels sprouts, broccoli, cauliflower, garlic, eggplant, avocado, leafy greens, onions, or squash, and except for the occasional banana, he didn’t eat much fruit either. Hamburgers with mashed potatoes and peas, a broiled steak with some french fries and a tossed salad, and meatball subs from the pizza place down the block were some of Ike’s favorite meals. He would periodically eat some chicken, but not much fish. The lettuce in his salad was always iceberg. He ate white bread, and drank coffee, sweetened iced tea, and soda. He loved candy, pretzels, popcorn, and potato chips. His living room coffee table was always loaded up with a variety of these kinds of treats.

As a young man, Ike had become a smoker. Though he had tried many times, he was never able to quit. Every evening after dinner, he would retire to his favorite chair in the living room to unwind from the stresses of the day. He would relax with a cold beer, while he snacked in front of the television, and smoked his cigarettes.

Though he was very physically active, Ike didn’t live a very healthy lifestyle. He was never given the tools to manage the stresses of daily life. He worked a difficult and often hectic job. As many people do, Ike tried to relieve his tension with junk food, a cold beer, and a pack of cigarettes. Additionally, Ike’s regular diet was highly inflammatory, and almost devoid of any phytonutrients, or antioxidants. It was also, very low in fiber, high in sugar, and high in refined carbohydrates. His lifestyle and diet where important contributing factors in the disintegration of his health, and his early death.

The quality of the foods we eat, have an undeniable impact on our health, our weight, and on our mortality. Foods trigger hormonal and biological responses. Foods can cause, or mitigate inflammation. The foods we eat can boost our health or steal it away from us.

Dr. David Ludwig is a highly-regarded endocrinologist, researcher, and professor at Harvard Medical School. He is also the director of the New Balance Foundation Obesity Prevention Center at Boston Children’s Hospital. He has spent years researching how food affects hormones, body weight and well-being.

In his 2016 book, Always Hungry, Dr. Ludwig wrote, “After every meal, hormones, chemical reactions, and even the activity of genes throughout the body change in radically different ways, all according to what we eat. These biological effects of food, quite apart from calorie content, could make all the difference between feeling persistently hungry or satisfied, between having low or robust energy, between weight gain or loss, and between a lifetime of chronic disease or one of good health.” To sum it up, a calorie is not, just a calorie.