Eat less, move more and get fat by Dr Trudi Deakin PhD | PHC Conference 2019

[Music] our next speaker who does have a tremendous amount of energy when it comes to thorough research or when I mean thorough it's the most I've ever seen okay well it's a fantastic dr. Trudi decayed PhD so last year came on after Tim Noakes and then the day I come on after Tom Watson so thanks Sam I'm getting really I'm a rebel dietitian that loves to use the f-word so when here we go before star just what to ask the audience how many people here how many people know somebody who has eaten less move more and put weight on yeah and do you fully understand the science behind that yeah so shall we finish down just go to the pub well I'm just gonna explore that topic a little bit more so disclosures I'm employed by the charity expert health and we are governed by the charge Commission and as a general principle myself north charity will take funds from Big Pharma or big food however last week I couldn't resist in entering into a debate I into until a lot of debates and this debate was calories versus carbs you can understand which which side I argumented argued for and expert health did receive a speaker fee from Sanofi to do that but it wasn't for the promotion of any medications or anything like that so this morning I'm going to talk about the problem the proposed solution for that problem the limitations with that proposed solution a little bit around the science of metabolism and then finish off with the real solution so what is the problem in health today it's the levels of obesity isn't it so 2/3 of the population overweight and one in four adults are obese but we know that it's the visceral fat which is the greatest concern and since 1993 the waist circumference of females has increased by 6 centimeters and the waist circumference of males has increased by 3 centimeters and that puts almost half of women in the high-risk category for waist circumference and around a third of men so that's really scary now when people want to lose weight they tend to go to Google so if you're typing good little lose weight you come up with the NHS weight management plan it's really good to see that diet doctors there but that's probably because I go into diet doctor a lot so what does the NHS say is the solution it's all about calories and when people are educated count calories then they're also educated to consume low-fat foods because low-fat foods are lower in calories so this is the NHS weight loss plan and they focus on calories and they say - you know to lose half a kilo a kilo a week then women need to have an average around 14,000 calories and then around 19,000 calories per day to achieve that weight loss but hogewood sorry that would be a lot so I the 1,400 or 1,900 calories per day but doesn't the diet and nutrition survey tell us that's actually what people are having so is it a calorie problem we know it isn't so when people just focus on calories then it's basically eat what you want as long as you count the calories so the doughnut becomes okay the sugary drinks become okay and shock horror with the NHS kind of snack guide even I took my mom to a hospital appointment and there were the healthy options and milla cafe in the hospital so you know mom I'll get you a KitKat or milky way because it's a healthy option now because it has around 100 calories that's shocking isn't it so yeah it's the wrong tactic isn't it so when people eat less and move more yeah they create a energy deficit and will that energy deficit result in weight loss it will do in the short term but then what happens weight loss plateaus why does it Plateau it's because the basal metabolic rate the BMR reduces when the basal metabolic rate reduces how do people feel often disillusioned and it's a struggle of willpower isn't it so at some point they start to reintroduce the foods that they've been missing and what happens weight regain and so the setpoint then an individual because the weight regain is often you know puts them at a weight that is higher than they were before they started the diet so we all know that the diets the afterafter story from going on our weight loss diet solely focusing on calories low-fat foods and eating frequently results in weight regain and what does that do someone's willpower they say it's my fault their confidence reduced and they say I didn't try hard enough so next time they want to lose weight what do they do they do exactly the same so it becomes a vicious circle what's the probability annual probability of a male or a female actually achieving a normal body mass index one in 2424 people for females and one in 210 people for males actually achieve a normal weight that's shocking isn't it so certainly what people are trying to do to obtain a normal weight isn't working so let's look at this platter if someone requires 2000 calories a day and they eat so they take in 2000 calories a day and they burn 2,000 calories a day their weight will keep my main stable someone decides to go on a weight loss diet and reduce their calories without considering what they're eating they will juice the calories perhaps to 1,500 calories a day but what isn't recognized is that calories out or calorie expenditure isn't stable so the calories will also reduce eventually down to 1500 calories a day so there's a weight loss known as a plateau and if that individual is really really motivated I'll say oh I've plateaued what should I do I'll further reduce my calories so they may further reduce their calories down to 1200 calories a day but then the basal metabolic rate will adapt and also reduce down to burning 1200 calories per day and so there's a initial weight loss and then plateau plateau and what do we call this is called metabolic adaptation it's also known as adaptive thermal Genesis and what it is it's the Rieger reduction in resting energy expenditure below that that you'd expect for weight loss when so people lose weight their resting energy expenditure reduces because they haven't got as much weight to carry around with them Burt this metabolic adaptation is the reduction in that resting energy expenditure beyond that that you'd expect for the weight loss and this is what favors they regain often increasing that person's setpoint and we've known this for more than 100 years so in 1918 they did a study where they reduce the calorie intake in men by about a third to half and they saw a 12% reduction in body weight but they also saw a 30 percent reduction in basal matter rate and then the famous minestrone starvation experiment the my Ancel keys what they did is that the pork bales and a semi starvation diet for a few months and what they found is that they lost about 25 percent of their body weight and their resting energy expenditure dropped so the basal mats by trait dropped and these men also reported feeling cold tired depressed sex drive went down they became obsessed with food how many people do we see who feel cold and tired obsessed with food from going on a reduced calorie diet more recently probably all heard of the big loser the us competition and it's done through eat less move more and they followed these individuals up you know initially they lost fifty eight kilos it's just a lot of weight to lose and they followed up at six years and at six years the weight gain of being 41 kilos so a majority of the weight loss of being regained and they looked at the metabolic adaptation they would expect it by the weight loss that people would have a reduced energy expenditure around 200 calories but what they found is that the reduced energy expenditure was around 700 calories 500 calories more than what was expected and even though these individuals have put the majority of the weight back on that metabolic adaptation remained so it means that for the rest of their lives these individuals have to eat 500 calories per day just to maintain their weight so that's caring it's depressing there's also limitations with move more because if people saw lay move more to lose weight we know it's not effective and that's because exercise is only a very very small proportion the total energy expenditure so total energy expenditure is a psalm of basal mat bitrate which is about 70% of the total energy expenditure and then TF is the energy that we use when we process food will digest food so it's a thermogenic effect of food neat is the non-exercise activity thermogenesis so that is the exercise that you burn when you're just general moving not exercising but just general movement throughout the day the e P or C is the excess post-exercise oxygen consumption and then you've got the exercise now if an individual's follows the physical recommendations of 30 minutes activity per day then that may only amount to about 5% of the total energy expenditure for that day so is it really going to contribute to weight loss so we know the benefits of exercise you know for general health but it's not the best way to lose weight and that is probably because 30 minutes is an insufficient amount we also know that physical activity can drive the hunger hormones like grayling and also we know especially with children when they're forced to do activity at school then they have more sedentary time outside school so that the you know the general movement slows down if people go to the gym for half an hour this sits around for the rest of the evening saying or what do my exercise for the day so moving on to the science now we're either in the fed state or the fasted State and when we're in the fed State if there's carbohydrates have been consumed then we produce insulin and what does insulin do it's an energy storage hormone so when we produce insulin then we are storing energy from food in conditions like Taiwan diabetes whether people don't produce the insulin then low insulin so people on a low carb diet also low insulin means that we can take fat from our adipose tissue and use that for fuel in the body so insulin means energy storage and knowing Sallee Hall low insulin means energy fuel and that's the difference between life or Genesis and lipolysis now why is instantly important where we know that insulin drives obesity so this is the graph here showing that in normal lean individuals both glucose levels and insulin levels although now they bolded dots here on the insulin so as people gain weight then you can see that insulin goes up so obesity is a condition of hyperinsulinemia but even in advanced diabetes type 2 diabetes here you see here that the insulin levels are much much higher at baseline than they are in lean individuals and post primary as well so type 2 diabetes and obesity conditions of hyperinsulinemia and we know that hyper anslee Mia is a driving force of many conditions that we see chronic conditions that we see in today's health we've known that type 2 diabetes is condition of hyperinsulinemia since 1960 but what we're very good at is treating the symptoms of type 2 diabetes blood glucose control rather than treating the cause of diabetes and in the UK we don't even measure insulin levels unless it's under research conditions so diabetes is more than doubled in the last 20 years and these are graphics from diabetes UK so we know that we have four point seven million people diabetes now ninety percent of them have type-2 diabetes and that's one in 15 individuals so one gets diagnosed with diabetes every two minutes that's really scary and furthermore there's twelve point three million people at risk of developing diabetes mainly type 2 and this is a study that's being done very recently in Western Sydnee and it tells me that actually the Diabetes UK estimates could be an underestimate because this is saying that you know they tested 61 thousand individuals and they found that the prevalence of diabetes was seventeen point five percent and the prevalence of pre-diabetes 30 percent so that's almost wrong in two adults having either pre-diabetes or diabetes and it could be the same in the UK but like I said insulin isn't measured in the UK so there could be even more people at risk because we talked about the metabolic syndrome and blood glucose control is only one of the five criteria considered in the metabolic syndrome so there might be even more people out there who've got normal blood glucose levels but who have a high waist conference high triglyceride levels low HDL and raise blood pressure so these people could also because we say that insulin the metabolic syndrome is a condition of insulin resistance so I just think it's a coincidence if two-thirds of the population is overweight then it's very very likely at two-thirds of the population also have insulin resistance and hyperinsulinemia and why is insulin resistance a problem well it's a vicious cycle isn't it so we know that if people eat carbohydrate beyond their carbohydrate threshold level then it's converted to fat and then the cells can resist the insulin so that drives to beat cells in the pancreas to make more insulin I mean people to feel more hungry and tired so they consume more food and most people consume more carbohydrate food so that vicious cycle goes round and round around we know then insulin levels are low and I've already explained this when insulin levels are low such as in undiagnosed type-2 diabetes or in people following a low carbohydrate or intermittent fasting dietary approach we know that fat burning opportunity in the body the lipolysis increases so the fat breakdown in the body increase so you can fuel from fat but in perhaps two-thirds of the population instant levels high so down here instant levels are high then highest levels mean that the body is in the fat storage mode so the lipogenesis the new production of fat and so how easy is going to be for these individuals to lose weight it's not going to be easy it's going to be very very difficult and this study here is showing us that you know the the amount of free fatty acids in the plasma significant reduces when there's an insulin infusion so when we injected Sling into an individual their ability to use fat for fuel reduces and that's why people we put people with type 2 diabetes so instantly that's why the gained weight this is also interesting so here there's no flux of fatty acids going either into the fat cells or into the circulation when we're fasting here so the overnight fast there is a flux of fatty acids leaving our fat cells our adipose tissue and going into circulation because we're using those as fuel to fuelers give us that energy source as for sleeping or if you're practicing intermittent fasting but when people consume meals breakfast lunch and evening meal the flux of the fatty acids are going from the circulation into the adipose tissue and that is because in a fed state we're storing energy and we all know people that can perhaps eat what they want to not put weight on and they're probably very very insulin sensitive so they produced just the right amount of insulin for the amount of carbohydrate they've eaten but those people who have a weight problem or struggle with their weight they produce here a lot more insulin compared to those people who are more insulin sensitive so which nutrients impact on insulin levels the most we all know it's carbohydrate and that's why we know that the effectiveness of carbohydrate diets so when we eat food breaks down to carbohydrate protein fat and carbohydrates the early nutrient that directly impacts on blood glucose levels so a slice of bread 15 grams of carbohydrate what are the building blocks glucose so starch is just building blocks of glucose three teaspoons of sugar 15 grams of carbohydrate but the board it building blocks are slightly different because it's half fructose and half glucose fruit just got even more so small hundred thirty gram Apple fifteen grams of carbohydrate but there's slightly more fructose on the green dots there in the fruit than glucose and then we've got lactose in milk what is lactose half a pint of milk 15 grams of carbohydrate and it's half glucose and half galactose just that really matter well the glucose goes directly into the blood but the fructose and the galactose gets processed by the liver first so the glucose stimulates the rise in blood glucose levels whereas the fructose and the lactose gets stored in the liver initially as glycogen but if glycogen stores are full a process of de novo lipogenesis which is new production of fat converts it to triglycerides and that's what can cause the fatty liver so the glucose in the blood stimulates the insulin produced in the pan beat cells in the pancreas and these thing acts like a lock it fits into the keyhole and the cell wall unlocks a door and allows the glucose to leave the blood and go into the body cell so it can be converted into energy and we can go about our normal daily activities so what are normal blood glucose levels between three point five and seven point eight so what happens when an individual or four consumes or eats carbohydrate beyond their carbohydrate tolerance level they produce more insulin and the insulin levels increase and what does that do it causes people to store more energy in the cells which causes the overweight cells the cells become stuffed initially full of glycogen and then full of fat so the cells become overweight and start to resist the insulin and that's how the insulin resistance is formed so then blood glucose levels can start to rise and the symptoms of diabetes of polyuria and thirst can start so when he see he glucose been flushed out of the kidneys and into the urine so carbohydrates are the only nutrient that directly impact on blood glucose levels so when people eat carbohydrate of both their tolerance level they get the highest lling levels the highest levels drive the weight gain and the and because they're in energy storage mode that person feels quite lethargic they say you know I've patients come in to see him in they say I feel tired all the time I feel hungry all the time and they shouldn't do it because they've got plenty of energy surrounding their body but they just can't access it so that drives eating and that drive such a behavior so we can call that starvation in the midst of Plenty it's like going out and going to the food store and buying shopping for the week coming home putting in the refrigerator but then putting a padlock on that refrigerator the family's going to go hungry and in a sense that's what is happening to people when they've got high insulin levels and their bodies in energy storage mode the storing all that energy which means that they've got padlock on their energy starts all stores and their body their fat stores in their body they cannot access them and they can't use them as their energy source so we need to help people to remove that padlock no healthy adult should go hungry so at the top corner here top left-hand corner here we've got an athlete a woman with just 10 12 percent body fat weighing 45 kilos how many calories of fat do you think she has got stored in her body go mm yeah I calculated it 44,000 she should never got hungry she should better utilize the fat stores as an energy source the woman in the middle here she's 70 kilos she's got the normal amount of body fat 25% something like that she has a hundred and fifty-seven calories of fat stored in her body the obese individual at the bottom right hand corner she weighs 95 kilos she's around 50% body fat she's got four more than 400,000 calories of fat in her body why would she say I feel tired and hungry all the time that should never happen what's causing that to happen and what is the solution what is the real solution for this reducing sling and the best way to reduce insulin is to reduce the refined carbohydrate so it's thinking about what you eat and when you eat it's not about counting calories so we educate people to understand what their carbohydrate tolerance is because it's probably different to all of us and so it's good to help people to experiment say what is my carbohydrate tolerance level and looking at meal frequency because we even know we know that carbohydrates has got the greatest impact on insulin levels we also know that protein could stimulate insulin and an even fact unless you eat fighting isolation so meal frequency is also really important if people having breakfast snack lunch snack evening meals supper then they're going to be in energy storage mode for most of the day and so just cutting out the snacks the green section there's the amount of time that people can dip into their fat stores and use that as an energy source so you're simply cutting out the snacks can help people to lose weight but time restricted eating has also become very popular so just missing a meal so some people miss evening meal some people might miss breakfast but cutting down to one or two meals a day can really really help people to unlock that padlock and utilize their fat stores as an energy source and that's what people want to do when they lose weight do they want to lose muscle no they don't when they lose way they want to lose that we've seen so observational studies have shown that people who eat on three or fewer occasions a day are more likely to have a lower body mass index and also having extended overnight fast of at least 12 hours has also has been shown observational studies to lead to reduce body mass index they've also done experiments where the compare compare continuous energy restriction with intermittent energy restrictive and you can see here that's oh this almost twice as much weight lost from people who practice intermittent calorie restriction compared to continuous because it doesn't damage the basal metabolic rate and you can see here that the metabolic adaptation is 500 calories a day less with the intermittent energy restriction compared to the continuous energy restriction so they have done work recently in people with pre-diabetes and diagnosed diabetes looking at eating over a six-hour period rather than a 12 hour period and the cold date so the people who could rule out to eat over six hour period could eat anywhere between 8 o'clock in the morning and 2 p.m. in the afternoon where was the people who were allowed to eat over 12 hour period then could eat anything between 8 o'clock in the morning and 8 o'clock at night they controlled their weight so they didn't lose weight they want to see there was a advantage of intermittent fasting slowly down to meal frequency and so the critics couldn't say oh it was down to the weight loss so they kept way constant and what they found is that reduce insulin levels improved insulin sensitivity reduce blood pressure reduce inflammation and oxidative stress now interestingly fasting triglycerides who went up why would that be because people are utilizing their fat stores as an energy source so you have more fat in the circulation because it's speed in the body and then people say well fasting is a score drive hunger it's going to cause disordered eating well there's many evidence for that the studies have shown that there's no compensation we eating because the hunger hormones reduce like renning instantly reduces and this is tightiy hormones such as pyy actually increase so it's the opposite of what people would think now it's not just a we have to look at Heppell whole lifestyle and we know that if people are permanently stressed and sleep-deprived even if they're not eating carbohydrates their body may be on a high carbohydrate diet so how could that happen it's about the stress hormones like cortisol this is the normal pattern of cortisol over a 24-hour period so we have on waking in the morning we have a peak in cortisol levels and why is that well the cortisol wakes the body off for the day so we used to say that breakfast was the most important meal of day because we needed energy but if we don't eat breakfast do we fall flat do we faint no we don't because the cortisol channels our liver to release glucose into our circulation so that gives us an energy pulse first thing in the morning but what happens if somebody's permanently stressed their levels of cortisol become elevated chronically stay up throughout the 24 hour period and so that tells the liver to make new glucose from pearl so it releases the glycogen stores into glucose but also it tells the liver to make new glucose for every hundred grams of protein you eat you can make 56 grams of glucose for every hundred grams of fat you eat you can make 10 grams of glucose so we can make glucose from other nutrients and that's why carbohydrate isn't essential nutrient but did you know that the liver has got potential to make 600 grams of copper glucose carbohydrate a day so someone might be really strict took a low carbohydrate diet but still not achieving their weight loss of blood glucose level targets because they're really stressed so they're not sleeping well so we do look at a need to look at the whole person in their lifestyle when people are able to fuel off fat and a ketogenic diet then what happens to the basal metabolic rate nothing it doesn't reduce so there's no metabolic adaptation they're allowed to because the body doesn't need to go into dietary starvation mode and the body doesn't need to conserve calories because the body's being fed not through what that individual is eating the body is being fed from their fat stores so it doesn't need to slow down and reduce basal mattify so now we have the tools we have the information to really help people rather than being a starvation in the midst of Plenty we can help people to own that lock that padlock and fuel from their fat stores and therefore succeed in achieving their weight loss goals so the take-home message really is if you want to get fat then certainly go ahead and eat less and move more but if you don't want to get fat then I'd say eat less frequently certainly move more we know that's good for us but only eat real foods and that way you can actually lose the fat and keep it off [Applause] [Music]

Channel: Public Health Collaboration

Views: 23,045

Rating: 4.8156028 out of 5

Keywords: diabetes, diet, nutrition, health, public health, low carb, obesity

Id: DnZOysd-i4I

Length: 32min 52sec (1972 seconds)

Published: Wed Dec 18 2019