Hormones in Weight Loss (The Obesity Code Lecture part 2)

all right so this is the part three of six this is the lecture series the etiology of obesity we really talked about what the what causes thus to gain weight and what we can do to try and lose that weight so this is the way that we understand obesity right now so as you can see we have the main player here is the insulin so if the insulin level is too high that's really what drives the obesity and it drives the behaviors of gaining weight and there's the first thing that was recognized was that carbohydrates especially the refined carbohydrates tend to make people gain weight and that's been known for many many years if you were to ever ask your grandmother you know she'd say stop eating sugar stop eating starchy foods and those foods which are the called the fattening carbohydrates you know mostly like flour and sugar bread potatoes those things tend to raise a serum insulin but it wasn't enough because what happens over time is that high insulin levels as we explained in the second part of the series actually causes you to develop resistance the resistance actually feeds back in a vicious cycle that is as you have higher insulin levels you have higher resistance as you have higher resistance you then have higher insulin levels and it goes back in a vicious cycle so pretty soon it's no longer the foods which are driving the high insulin levels it's the it's the insulin itself which is driving the high insulin level so it's important to try and break the cycle somehow and that's what we really have to know because for a lot of people they cut out with all these refined foods and yet they still can't lose any weight because it's this may not be the driving force anymore so pretty soon after around the 1990s there was a big movement towards low carbohydrate diets which was popularized really by the Atkins diet the American Heart Association had been providing dietary advice for many many years and what they had always advised was a low-fat diet as since the 1960's Atlee so they're suggesting a range of 25 to 35 percent total fats and low cholesterol the problem was that it didn't really work because you know despite that advice people continue to gain weight so low carbohydrate diets have actually been around for many years so the first published report of low carbohydrate diet was in 1936 by the 1950s it was actually fairly popular so there is a doctor by the name of doctor Pennington who wrote a article in the New England Journal of Medicine talking about low carbohydrate diets and in fact what happened was that dr. Atkins was in medical school or learning at that time so he learned from dr. Pennington and read the article so his diet he didn't actually invent the diet he said that he tried these diets because well that's what they taught him in medical school sort of thing so what happened was that dr. Atkins was a cardiologist and he had started to gain weight much like the rest of us kind of a pound a year two pounds a year but slowly over those years he started to gain weight he couldn't lose the weight with the standard low fat diet and then he tried different things but eventually he said because that's what was taught at the time he tried a low carbohydrate diet and what he found was that very quickly all that weight came off so he was working at AT&T at the time and he decided to try it on a few patients and he found that is extremely successful so he actually went on to kind of popularize it it got published in Vogue magazine and then he went and published his book the new diet revolution which became one of the fastest and best-selling diet books in the 1970s it kind of enjoyed a little bit of a popularization but these are not fad restricted so there is a real clash between him and the American associate art Association by the 1990s it kind of got revived as a low-carbohydrate high-protein diet and for a few years it was very very popular so in 2000 when these diets were extremely popular the American Heart Association they hated this diet right they thought it was like just the worst thing they thought it was really killing people so they published some guidelines and they compared these diets the low carbohydrate diets to the reduced fat diets and this is from one of their patients and what you can see is that the reduced fat diet is a calorie restrictive diet whereas the low carbohydrate diet is not you restrict your carbohydrates but you don't restrict your calories the other difference is is that there is a friction in both of the food choices the and what they note is that with the reduced fat diets you have gradual weight loss but you have much faster weight loss on the low carbohydrates actin style diets and they were really concerned that it was unhealthy but if you look you know both of these were unproven but if you look at the cholesterol changes you see that on the reduced fat diets you have no difference in the LDL this is the bad cholesterol the good cholesterol tends to increase more with the Atkins diet which is actually a good thing and the triglycerides tends to decrease more on the Atkins diet which is also a good thing however on the final part they said that well we have all these concerns about the Atkins diet that is because it's high-protein you might get kidney stones it might be bad for kidney or liver patients and they're concerned particularly about this the a Trojan issah T that is it's clogging your arteries right that's the real big concern and the concerns they have about the reduced fat diet was none they actually thought this diet was just great this is really the way to go and this is not that long ago that is about 12 years ago so starting around 2000 there was a number of trials published which were really comparing one to the other because they really wanted to show that the people that these Atkins diets were very very dangerous to you so the earliest trials started getting published around 2003 so this was published in the New England Journal of Medicine and they basically took 132 patients and they randomized them that is half of the group they gave a low-fat diet and half of the group they gave the Atkins style diet and they wanted to see what happened at the end of six months and what they found was that in the short term at least the action style diet actually did much better so whereas the low-fat diets they were recommending dropped about two kilos the other diets dropped closer to six kilos so much better short-term weight loss another trial which was fairly well publicized at the time was published in the Journal of the American Medical Association in 2007 and basically they actually they took four different diet plans okay so 300 patients they randomized them so you know they took a group of people and randomly assigned them to four different four different diets and what you can see is that one diet really stands out as having more weight loss than the rest and that diet turned out to really a lot of people surprise was the Atkins diet because everybody had been calling this a fad diet and thought it was very bad but it turns out that there was actually substantially better weight loss on the Atkins style diet so the other three which is the zone the Ornish and the standard which is a kind of low fat diet they're all fairly similar so they lose about two kilos whereas the Atkins diet was about twice as effective in the short term so it really looked like these low carbohydrate diets to really a lot of people surprised was actually better at causing people to lose weight the other thing that was actually a bit of a surprise to myself when I read it for the first time was that they actually look like they were better for you because again if you look at the difference between the Atkins diet which is a low carbohydrate versus the Ornish diet which is a very low fat diet you compare not just the weight but you start to compare some of the other you know lab work and blood tests you can see that they actually started to do better so this is the good cholesterol the HDL is the good cholesterol so on the Atkins diet it actually went up about five points whereas note the orange diet cause no change so in fact this is better in terms of the Atkins if you look at the triglycerides higher levels or lower levels are better for you you can see that the Atkins diet also had better triglyceride so the the good cholesterol was better that triglycerides was better on the Atkins diet if you look at the measures of the sugars you can look at insulin you can look at glucose and this is a three month average of your Sugar's called the hemoglobin a1c you can see again all three of those measures were significantly better on the Atkins style diet and finally even on the blood pressure you can see that the blood pressure actually was better on the Atkins diet so the blood pressure went down about seven point six whereas the standard diet only went down 1.9 so really on a lot of measures the Atkins diet was really a lot better in fact this is the the lot of the the same problems that kind of clustered together so people who have the problems with weight also tend to have the sugar problem the cholesterol problem blood pressure problem and all of those seem to be better on the Atkins diet so another another trial which was published shortly thereafter which was again in the New England Journal of Medicine looked at the same sort of things it was done in Israel and what they did was they actually had this was one of the best trials done because they actually did it at at work and they did it so that they had the lunch given to the people so the dietary compliance was very high that is people are kind of giving you what to eat or you're choosing what to eat from separate booths right so there's three different booths one is a kind of Mediterranean diet one is a Atkins style diet one is a low fat diet but instead of having to make your own food at the lunchtime at the workplace they would actually do just go to different places in the cafeteria so the compliance was very high and what they wanted to see again was what the difference is between these three diets and what they found is that the the one diet which really stands out the Mediterranean and the Atkins stood out as better but one the one that stood out is really bad compared to the other two is a low-fat diet this is the American Heart Association diet and the diet that we had actually been telling all our patients for the last 3040 years to follow in fact it was really the worst one of all both the Mediterranean Act and the Atkins diet shown here and here were actually much better for you but again that's not the surprise because by then we kind of already knew that the weight loss was better but what was this the big surprise was that it looked like a healthier diet so you could measure these other things such as again if you look at the cholesterol levels this red bar is the low-fat diet and again it really stands out as the worst diet in terms of all these parameters of the cholesterol so if you look at the good cholesterol so higher is better you can see that the Atkins diet was the best one if you look at the triglycerides again the lower is better you can see that what stands out here is that the the low-fat diet the Heart Association diet was the worst of them all again not much difference on the LDL which is the bad cholesterol but the ratio of the the bad to the good cholesterol again what stands out is that the best one is the Atkins and the worst one is the low fat diet so again a real surprise to many people if you look further at something called inflammation so we measure inflammation with this thing called the high sensitivity CRP and that according to how high it is you can see how much risk you are at heart disease and strokes and that sort of thing so the lower your inflammation the better and again what really stands out is that the low-fat diet the Heart Association diet was the worst and the Atkins was really the best if you look at the sugars again this is that three-month average of hemoglobin a1c you can see that the best one is the Adkins the worst one is the low-fat diet so surprisingly it was you know these these diets had shown to be much healthier than the previous ones and these are the ones that the the Heart Association was really really fighting against but it seemed it seemed to be the opposite it not only caused better weight loss but it seemed that it was much healthier for you the other thing that's really important with weight loss is not simply the initial weight loss but whether you can keep it off because really that the the key is that in a six-month study you often see that people lose weight but then over the long term it all seems to be regained so there was a few trials that had looked at that and we've talked about that in the first session about why you regain that weight and how the body acts really as a thermostat there's like a setpoint and if you don't adjust that setpoint what happens is that the body actually tries to regain that weight so they looked at several different diets in terms of how well it keeps the weight off as well so this is a trial published again in the New England Journal of Medicine and they took 773 patients and again there are randomized after they had lost 10% of their weight so for four different groups they had either they adjusted the protein so LP is low protein HP is high protein or they adjusted it according to the glycemic index which is how high the sugars rise after each food and so you can have a high glycemic index or a low glycemic index so high glycemic index are those foods that raise the sugars like the sugars and the starches and so on so after they lost the weight they randomized them to these four groups and again you can see that again most of the groups regain the weight there was only one group really which stood out that didn't seem to regain that weight over the next six months and that was the high-protein low glycemic index so these fattening carbohydrates seem to have an impact impact not just on the initial weight loss but also keeping it off so again this was a this was something that was published in the New England Journal Medicine and it was really a bit of a surprise to a lot of people that not only are they cause better short-term weight loss but they are also are healthier and they may have a bit better effect in terms of the durability of this recently a study was published by David Ludwig in 2012 looking at why this is and remember we talked about the energy expenditure that is after a certain amount of weight loss your body actually reduces its energy expenditure and by reducing its energy expenditure that is how many calories you burn on a daily basis you actually start to regain a lot of that weight so he took he took a number of patients and put them on three different diets and tried to see what the difference in energy expenditure was so there is three groups the low fat low glycemic index and a very low carbohydrate you can see that the low fat group here on the Left actually seems to cause the greatest reduction in energy expenditure that is if you normally expend 2,000 calories a day after you go on a diet your energy expenditure will go down that is instead of expending 2,000 calories a day might go down to 1,800 therefore if you continue to eat 2,000 you will actually regain some of that weight and it's the effect seems to be the worst in the low-fat diet the American Heart Association thought that we had been all told to follow and the least reduction almost no reduction was the very low carbohydrate so that might explain a little bit why of why it might have been a bit more of a durable effect in the same article he notes that these low glycemic load in diets which are low in carbohydrates they actually tend to be the healthiest in terms of the triglycerides and the cholesterol as well so really if you take all these studies all these recent studies that have been published really within the last 10 years they're all remarkable in their consistency that is they really show the same thing one is that diets really are quite hard to follow because the or what diet you put people on there's about a 40% dropout rate that is even on the Atkins diet versus another diet they're not particularly easy to follow people tend to go back to what they're used to eating the second thing is that if you're going to look at short-term weight loss the Atkins seems to do the best and really the best metabolic profile so both in terms of sugars cholesterol and weight tends to be on an Atkins style diet and two things that we've always kind of been told but really don't seem to be true is that eating fat does not make you fat so that's cause something that kind of been talked about for a while but it's clear that the high fat diets such as the Acton's diets are not actually that fattening in fact they may actually be better for you than these high carbohydrate diets past the rich rice diets or the other thing that's really interesting is that eating cholesterol does not raise your cholesterol because again you've seen the packages low in cholesterol you know no cholesterol it's actually irrelevant but how much cholesterol you eat because if you look at the Atkins diet they're eating double or triple the amount of cholesterol that the low fat people were eating yet their cholesterol were substantially better the good cholesterol were higher there was no difference in their bad cholesterol but the triglycerides were like 30% better so all those all those packages that say low cholesterol you can ignore them because it just simply doesn't matter the same goes for foods that are high in cholesterol high in dietary cholesterol like shrimp and egg yolks it doesn't there's no reason that you need to - to avoid them because the dietary cholesterol really has very little to do with your cholesterol okay so all these people who are eating high cholesterol diets they didn't do worse in fact they did better so if you look at the metabolic syndrome the metabolic syndrome is a cluster of risk factors for heart disease and they all seem to run together so I've listed on the right here the American Thoracic Society criteria for metabolic syndrome and on the left here I've indicated what we know about diets and particularly diets high in refined carbohydrates so the fattening carbohydrates such as pastas and breads and so on and what you can see is that the criteria the the medical criteria for metabolic syndrome is abdominal obesity which seems to be made worse by these diets high in refined carbohydrates the second thing is the triglycerides being high that's one of the characteristics of the metabolic syndrome and again we know that these diets high in refined carbohydrates also tend to be worse for the triglycerides the good cholesterol HDL is low that's part of the metabolic syndrome and again that's one of the things that you know you're going to get when you follow the low-fat diets high blood pressure again and high blood sugars all of these are made worse by diets high in refined carbohydrates so remember the scariest part of this of all of course is that these diet this diet this low-fat diet was the exact diet that we've been told to follow for the last 40 years and all of these things are exactly the ones that we get when we get metabolic syndrome and there's been this explosion of metabolic syndrome within the last 20 years and why is that is that because patients weren't listening to their doctors hardly this is exactly what we've been telling people to do it's actually because patients were listening to their doctors they were following this low-fat diet they were trying to eat more bread more bread more pasta because it was low in fat it was low in cholesterol you know avoid the meat than the eggs and you threw out the egg yolk because you're didn't want the cholesterol and all that sort of thing and then you ate another couple slices of bread it turns out that that's just going to give you the metabolic syndrome that's exactly what we saw it wasn't because you weren't listening it was because you were listening and insulin resistance is really the key to the whole metabolic syndrome you can see it when you when you take patients with the same weight so you can take patients with the same body mass index that means it's they're the same weight and you can divide them into a group three groups one group with low insulin resistance medium and high insulin resistance and then see what the difference between those three groups are so okay so these three groups of patients are all the same weight they're all apparently healthy that is they don't have any disease that you know of and split them into three groups according to their insulin resistance and you can see that there's much higher hypertension so high blood pressure much worse cholesterol is rides much worse of the good cholesterol and the impaired fasting glucose which is the sugars so all of these things tend to run together and it's all dependent on the insulin resistance the insulin resistance is really the key to the whole metabolic syndrome insulin resistance is diabetes it's also the same thing and what you can see is that these diets may depend on how much insulin resistance you have because they took this is a trial done a few years ago they took 73 patients and again randomized them to a low-fat diet and a low glycemic load diet so low in carbohydrates you know Atkins style and overall there was no difference but when they split the groups into insulin sensitive and insulin resistant groups what they found was that the insulin sensitive group there was no difference but the insulin resistant group they did much better on the low carbohydrate diet that is if you're starting to get diabetes if you're very sensitive to those carbohydrates is better to restrict them the other thing that's very interesting is that we all worry about eating too much fat and eating too much cholesterol because we thought it would make us fat so the thing is that dietary fat which is predominantly triglycerides funny enough it actually doesn't raise your triglycerides so you think that eating these triglycerides eating this fat is going to make your triglycerides worse because it is triglycerides but it doesn't because what happens when you eat a lot of this dietary fat is that your body actually shuts down production of its own fat its own triglycerides so in the end there's actually no difference in your levels of triglycerides so these are this is you know the highest the higher the triglycerides the worse it is on the other hand if you eat a lot of refined carbohydrates what happens is that this actually has no triglycerides but because of the effect on insulin it actually turns on the production of fat so it turns on the production of triglycerides and what you get is you get all this fat accumulated in the liver you get all this fatty liver so your liver is big and some and this is actually one of the major causes of liver failure so even though the carbohydrates don't have triglycerides it turns on the production of triglycerides whereas if you eat fat it actually doesn't make any difference and we actually already knew this because if you look at foie gras which is the fatty liver of a goose or doc we know how to give Doc's fatty liver you force-feed them so this is how they make foie gras they take a bucket they shove a tube down the poor duck's neck and they feed it they force-feed it food okay and what is the food that they use high starch corn mash because if you give it protein of course it's not going to do anything so they give it carbohydrates they give it lots of carbohydrates and what you get is the duck or the goose suddenly gets this big fatty liver and then when you kill it you get foie gras which is a delicacy but we know how to give ducks fatty liver it actually is the analogous situation in humans the excess carbohydrates or excess refined carbohydrates is what's going to give you the fatty liver so if we look at the hormonal obesity theory as we understand it now so not only so the the insulin levels is still the key player the fattening carbohydrates is a key player the insulin resistance as we see is very important it's really the key to the whole thing fiber is protective because it tends to decrease your insulin levels but we can see that it's not simply obesity anymore we're talking about it's actually much much more than that we're talking about obesity hyperlipidemia so high triglycerides low cholesterol low low good cholesterol high blood pressure diabetes and fatty liver this metabolic syndrome which all goes together is actually part and parcel of the whole insulin resistance syndrome so you can see that you know by attacking your insulin levels you're actually doing far more for yourself than simply losing the weight it actually impacts all those things that we try to treat with medication for the most part now there's a few things about the Atkins diet which people have always worried about so when it was very popular they used to there's all these arguments why you shouldn't do the Atkins diet one of it was that it was all water that is you know all the weight that you loses water and that's true because if you lower your serum insulin levels by eating these foods low and refined carbohydrates insulin how's the body to retain salt and water so if you if you eat less of these foods and your insulin levels go down you will actually get rid of a lot of this water and in fact a lot of the initial weight loss that you see on the Atkins diet was water loss so you'd see you know five six pounds go within the first week that that's too fast to be fat loss that's mostly water loss and so they say oh it's just water loss but that's actually a good thing because who wants these big swollen ankles right we give people medication to get rid of the salt and water we give people diuretics blood pressure pills to get rid of the salt in water and so here's an all-natural way you can get rid of this excess salt in water you can see it because you don't get those swollen ankles but also the blood pressure tends to go because as you're getting rid of the salt and water your blood pressure may also fall which is exactly what you saw on the Atkins style diet the second thing that a lot of people say is that it's bad for the kidneys and this is a real concern because if it's the people who used to say if it's very high in protein like a high meat diet it may be bad for the kidney and part of it is true if it's too high in protein there certainly could be a concern about that but when they took those when they did those studies of people where they randomized them to high protein or low protein what they found was that in healthy people they actually could find no difference there's no noticeably harmful effects on the kidneys or any noticeable effects on the urine or the electrolytes or anything like that so two studies have been published on this already so in relatively healthy people there actually is no concern for the kidneys for kidney patients there probably is you probably do need to be monitored a little bit more closely but the major complaint people had with the action style diet was that it's nutritionally unbalanced right so this is a picture of the choose my plate which is one of these government programs and you can see they've divided the plate into kind of four things one of the major things is the grain so like 1/4 1/3 half of your plate should be grains right and then there's fruits vegetables protein and dairy as well and this this is you know the balanced diet and that actually has a few things the underlying assumption is that for some reason they believe that refined grains actually provide essential nutrients right if it didn't provide essential nutrients it wouldn't be part of the thing so you can see that proteins and vegetables and fruits yes you can say that they are essential nutrients but grains for some reason they say that there actually is essential nutrients but there isn't the truth is that if you take a slice of white bread you really are getting no essential nutrients out of it in fact by refining it into white flour they actually have to add back nutrients because if you eat the unenriched flour you'll actually very quickly develop nutritional deficiencies so they actually had to add back thiamine and they had to add back folic acid they had to add back all these nutrients so the actual refined flours that they make pastas and breads out of they actually had no nutrients at all the other thing to remember is that in the body there are essential facts and there are essential amino acids that is essential proteins that is those are foods that you must eat in order to to survive you must have certain fats and you must have certain proteins but there are no essential carbohydrates so that is you could eat a diet which is essentially devoid of carbohydrates and still survive in fact many cultures have done this so the nu E and you know northern Canada they ate a lot of whale and blubber and that sort of thing the traditional diet nothing grows right there's no wheat up there right there's no grains up there so they actually essentially eight zero carbohydrates but it didn't matter they were still very healthy there are no essential carbohydrates so in fact the carbohydrate restricted diet should actually be healthier for you than the than the non one because you're actually forced to eat all these other foods which actually have nutrients the other thing they talk about refined carbohydrates is are they addictive because that's the thing if you have an addictive food then it's no longer just a hunger and that actually might be true because if you think about it there are many things which people say they're addicted to which is that they can't stop eating and if you think about them and I've listed some of them on the right they all tend to be very heavy in the carbohydrates that is the sugars or the flour so whether it's cookies or past those or brad's or candy people do get addicted to these that is you start eating you can't really stop but nobody ever says oh I'm addicted to Sam right I can't stop eating Sam like nobody ever says that so proteins or unrefined carbohydrates so carbohydrates but in their natural state nobody ever says oh I'm addicted to apples I can't stop eating them I just keep eating them nobody ever says that but for for things like bread which is not even that sweet there are people my son included and you just can't stop eating it he loves the bread and it might be because they're addictive a lot of people believe that and there actually is some data to suggest that these refined carbohydrates are actually addictive if you look at functional MRI studies that is they took people and they stuck them in an MRI and they gave them certain foods and they measured the blood flow in the brain what they found was this there's a difference between glucose and fructose that is fructose which is seen in a lot of sugars does not turn off the satiety pathway that is if you eat regular foods which glucose your hypothalamus which is the reward pathway eventually turns off so you eat enough you get full your reward pathway turns off you say okay I can't do it anymore but that doesn't seem to happen with fructose which is you know 50% of sugar is fructose it doesn't seem to happen that is you can keep going and going it doesn't seem to turn off you still feel that reward from eating sugars fructose that is if you eat for instance a slice of roast beef at first it's going to taste really really good but when you're full and completely stuffed it doesn't taste so good anymore it's not like you can keep going because the reward pathways are turned off but if you take ice cream which is full of sugar you can actually just keep going because these reward pathways never really turn off so it's possible that these things are addictive and if you think about a lot of comfort food so foods that give us comfort when you're feeling a little low you want to just get a little something to make you feel better again these are all foods that are very high in refined carbohydrates so you know apple pie and ice cream and they're all very high and they give you a bit of a reward because that's what they're meant to do but nobody ever suggests that oh you should go and eat a 10 ounce steak it's not really a comfort food it's delicious but it's not really a comfort food so this is one of the keys that if you try to over eat these unrefined foods it's very very difficult that is if you remember back we are talking about overfeeding studies where they take groups of patients and they try to make them eat to gain weight okay so Ethan Sims which is an endocrinologist who did these studies he would say that yeah you try and make them eat you give them a plate of pork chops and they'd sit at it staring at it for hours because you know when you eaten enough pork you just don't want to eat anymore right and it's the same with unrefined carbohydrates usse once you had enough you just can't keep going you can't just keep eating and eating the whole bushel of apples after a few you're going to say oh okay that's just enough but that's not true when you're talking about refined carbohydrates when you're talking about refined carbohydrates you actually can keep going you could keep going you could eat the whole tub of ice cream you could hold eat the whole stack of pancakes it just doesn't stop so there's no satiety hormones for these refined carbohydrates that is for natural foods we actually have a natural system to reduce to say that okay that you've had enough before these kind of refined refined foods we probably bypass them because these are foods that are not found you know in their natural state so we probably bypass the satiety signals which tell our body that we've eaten enough of those and that's the real key if you're going to eat natural unrefined foods it's actually very difficult to overeat them and in fact in this study with with a group of patients they gave them 14 days of a low carbohydrate diet very very tight restrictions 20 grams a day which is like the induction phase of the Atkins diet but they didn't put them on on a calorie restrictions you could eat as much as you want but what they restricted was the carbon my grades and they tent took 1010 diabetic patients and what they found was that their body weight went down but once you took away their carbohydrates the refined carbohydrates the calorie intake substantially decreased as well now what's even more important is that the insulin levels when you took them all away significantly went down so if you're eating a lot of foods that are high in carbohydrates refined carbohydrates your insulin levels just spiked up and that's really what drives the obesity in the long-term as well as drives the insulin resistance so what they said in the study was that when we took away the carbohydrates the patients spontaneously reduced their daily energy consumptions 5,000 calories a day so even though there was no restriction on how many calories you could eat they ate less anyway because they were full you just have to listen to your body not only that is but because the insulin levels went down the insulin sensitivity went up so this is at the end of it you can see that they had a much better insulin sensitivity and that gets back to the fact that it's the high insulin levels which drives that vicious cycle of high insulin and high insulin resistance so this is what we talked about in the hormonal vce theory that is if it's the high insulin levels which drives the resistance as your insulin level comes down then your resistance starts to come down as well but the problem is this what was the long-term results of all this because you know the Atkins diet was very popular in the 1990s in the early 2000s but it quickly faded it's not really all that popular anymore if you look at what people follow it just wasn't all that effective in the long term so in the short term it looked better and what was really important was that it was not a very it was not a dangerous diet by any means and might be actually healthier but when you took all these studies together and looked at long-term results this is what you found the weight loss wasn't as good as you thought it would be so at six months if you take a number of studies and kind of clumped them all together you see that there is about a four kilogram weight loss at six months which is about 10 pounds roughly but at 12 months it was only 1 kilogram so really not as good as you might have expected and if you look out at two years this is a study where they looked at low fat versus Atkins so there was no difference by 12 months and by 24 months it really wasn't as good as you thought it would be even in that initial study that was done in Israel the scheie study what they found was that ok at 6 months or 24 months because the compliance was so much better they were doing better the low-fat diet was not doing as well as the Atkins but by 72 months a lot of the benefits just kind of started to go away so it wasn't as good as you thought and the reason that people got confused with all this is that it's the insulin levels that you really need to keep a track of not the glucose level so a lot of these low glycemic index diets talk about the glucose but it's not the glucose which is important it's the insulin which drives the obesity so not only do the fattening carbohydrate raise insulin but it turns out that protein raises insulin as well so protein if you look at different foods you can measure how much they raise your insulin levels so certainly the worst offenders are here with the snacks the bakery products and the carbohydrate-rich foods ok so your breads your pastas your desserts they all raise insulin quite a bit but just after that the protein rich foods also raise your insulin levels so remember the protein like salmon and beef and so on they don't raise your glucose but they still raise your insulin levels so if you look at the the correlation between how much it raises your sugar and how much it raises your insulin it only accounts for about 23% of the variability so it's not a hundred percent that is foods that don't raise your glucose can still raise your insulin so again if you look at these are cereals so all bran and porridge and this is cornflakes honey Maxo they all raise your insulin scores but so do X G's beef lentils and fish so they also raise your insulin levels if it's the insulin levels which are driving your obesity these foods the high protein foods while not as bad as bread and pasta are still raising your insulin levels if you look at the three macronutrient so fat fat is probably the best because because they tend to raise the insulin levels the least if you look at carbohydrates for instance carbohydrates as you take more carbohydrates your insulin level tends to go up if you look at proteins if you look at proteins as you take more protein it tends to go down a bit but you can see it's only this one line most protein you can't eat that higher protein but the insulin lettuce scores are all over the place fat is probably the best because you can see there's a clear trend towards higher fat meals causing less insulin spikes but the scale of this is much less because this only goes up to 140 these go up to 200 so the protein foods while not as bad as the carbohydrate foods are still going to raise your insulin levels if you look at different proteins they actually have different effects so whey protein which is a dairy protein actually seems to have the highest effect on the insulin fish is also very high an egg seems to be one of the lower amounts so there is a difference just like with the carbohydrates if you look at the insulin resistance now this is a very interesting study looking at eight-year-old boys because what they did was they gave them protein basically either in the form of meat or in the form of milk milk has a lot of those dairy proteins which actually tend to raise the insulin levels the most so remember if it's the insulin levels that are going up that's going to be driving the weight gain and you can see that after seven days the insulin is much higher on the milk than the meat group but what's even more scary is that if you look at the amount of insulin resistance so high insulin levels can lead to high insulin resistance by day 7 you can see that the milk group has much worse insulin resistance than the meat group so even after seven days you can see these differences in response so certain proteins particularly the dairy proteins can be very high this is looking at again the difference between meat and milk these are milk and cheese you can see the insulin response is much higher with that then say for COD remember that insulin is the driver or obesity because not none of these foods are going to raise your blood sugar levels significantly and the other thing is that if you have a lot of insulin resistance that is also going to drive that vicious cycle of higher insulin levels this is the same sort of thing looking at milk and whey which is that dairy protein and if you look at the insulin genic index this is area under the curve how much insulin you've secreted in response to that food you can see that really milk and we're up here and this is whole wheat bread which is actually way down here so that's very interesting and much different from what we would have thought because meats are somewhere in the middle Cod cheese but milk is way up here and even worse than the bread now what's interesting is that there's actually a substantial amount of correlation of correlative data which looks at animal protein and diabetes so if you look at this is the animal protein and vegetable protein and they looked at this epic study which is a very large study done in Europe looking at the influence of diet and cancer predominantly but they also looked at proteins animal proteins vegetable proteins so animal proteins tend to be much more in slow genex that is animal proteins tend to raise your insulin levels more and what you can see is that if you break them into four quartiles so you take people and these are the people who eat the most animal protein and these are the people who eat the least animal protein you can see that there's a steady rise in your incidence of diabetes with the more animal protein you take now this is a correlation that is that this doesn't imply that one causes the other but certainly there's some kind of association between animal protein and vegetables and even more interesting is that they looked at the fish because everybody thinks oh fish is really really good for you and it is however you can also link the intake of fish with the incidence of diabetes so here again if you break them into five quintile so you break people into five different groups one which eats the most fish and one which eats the least fish and then you look at them and say who has the most diabetes you think that eating fish is really really good for you but in fact there's actually a higher risk of diabetes when you eat the fish not a lot higher but a little bit higher so there's clearly a correlation there and this is a prospective trial of almost 200,000 patients over 14 to 18 years so it's a very long-term study but because the fish also raised these is the insulin therefore you may also file as you take more fish you may get more insulin resistance which means that you have more diabetes so finally you can understand some of these studies which is looking at the weight gain so this is a very interesting paper that was published in the New England Journal of Medicine and they took 120,000 patients and they just said let's look at what they eat and how much weight they gained so on average they gained about 38.3 pounds every four years or roughly a pound a year which is probably average of what people do and let's see what they eat and see if there's any differences in what people eat so you can see that the foods here on the so this means that they gain more weight when you eat this food you can see that potato chips and french fries are very high on that list okay and that's no surprise because they're going to raise your insulin levels or fatty carbon they're fattening carbohydrate but right after that is meat so unprocessed red meat and processed meats that also tends to be fairly high and you wouldn't be able to understand it until you realize that the meat also raises your insulin levels it's all about the insulin levels the butter is the same because butter even though it's a lot of fat has a lot of this dairy dairy proteins the refined grains and the sweets for sure what is protect what is protective is these whole grains and fruits so a lot of people on the Atkins diet against these whole grains and that sort of thing but in fact in this study it seems to be correlated with a protective effect and that's possibly due to the protective effect of the fiber which we talked about the last time the fiber which is going to act to reduce the insulin which acts almost as an antidote reduces the insulin is going to be expected to reduce your incidence of diabetes as well as weight loss so this is what we have here so we have not only the zoo again the major player here is still going to be the insulin but not only the fattening carbohydrates but the animal protein are going to be very important and again the major players as you as you increase your insulin levels you get this insulin resistance which is a time-dependent effect that is the longer you have it the worse your effect is and what you can see is that most of what we eat actually are going to raise the insulin level so this is a from the food availability 2010 this is what Americans eat and you can see that the majority of what they eat are going to raise the insulin levels substantially so the meat eggs not so much nuts but it's lumped in there and that in that category the sweeteners the flour and the sugar and the dairy the added fats and oils I think are also very bad for you because we tend to eat a lot of these refined oils but we'll cover that in a separate topic the only thing which is not going to substantially be a problem for the insulin is the fruits and vegetables which is really only 8% of the diet so you can see most of the diet that we eat is actually quite insulin genic so a couple of other things that we have to talk about which is the hunger because this speaks to some of the other hormonal systems that we haven't really addressed yet because there's also an other the needs and a number of other factors one of which is the hunger so this is the way that hunger is it's actually mediated through the brain but there's a number of other hormones that are important so there's ghrelin CCK insulin leptin and what is interesting is that it some people feel that it's a necessary condition of losing weight you have to be hungry but actually it's not really true if you're hungry it means that your cell your body is not getting enough energy and it's very hard to ignore you can't just go hungry all the time you can do it for three months six months but you can't do it all the time if you get hungry you actually need to eat but it's a matter of selecting the proper foods which you need to eat so if you look at the satiety hormones that is the hormones that tell our body that were full there's two of them called cysts cholecystokinin which is CCK and pancreatic peptide YY and they actually act in the gut so as you eat food and particularly protein rich foods and fat-rich foods what you find is that they secrete CCK which is that hormone and it acts on the brain then same with the the pancreatic peptide YY in response to protein it's it's secreted and it basically feeds back to the body and tells you you're full so that's very important because as you eat protein rich and fat rich foods you will become full whereas that is not quite the case when you're eating highly refined carbohydrates when you're eating those there are no cause satiety hormones like that and that's why dr. William Osler all the way back in the ninth early 1900s said you must eat more fat because if you eat more fat your body will become full leptin was a very interesting topic which is discussed some time so leptin was discovered in 1994 and they thought it was so important they called the gene the ob gene for the obese gene and what leptin is is it's actually produced by the fat cells so as the as you get more fat cells your leptin level goes up and it feeds back into the brain and the brain says okay I'm over my weight you know don't eat so much anymore so they thought that oh this is what's going to be the case leptin is you're going to be have too little leptin therefore you're if we give people leptin that should make them thin and the drug companies were very excited about this they rushed out and they tried to make all this leptin so they took a number of patients and they just gave them leptin and according to this theory they should all lose weight the problem was they didn't in fact they didn't lose anyway it turns out that the the state of obesity is actually a leptin resistant state that is you're resistant to the effect of the leptin so your fat cells are producing this leptin which is telling your body that you need to lose weight but your brain is blocking it out it's resistant to the effect of the leptin and it's probably because of the insulin so as you have high insulin levels which leads to the obesity what happens is that your leptin level goes up but since your leptin level is raised all the time you just become resistant to it it's kind of like anything in the body if you you know take any hormonal system as you as you are continually exposed to that hormone your body eventually becomes resistant just like when you go from the dark to the light it seems very bright at first but then you adapt it's the same thing if you're always having high leptin levels eventually it just becomes resistant to it and it loses this effect so it turns out that that which a lot of people talk about is probably not that relevant anymore are the insulin by driving the obesity and the high levels probably caused the resistance so I'm going to spend the last part of the talk talking about cortisol because if you remember to the first part of the talk we talked about there's two systems really there's the insulin system which causes the obesity and the cortisol which also causes the obesity so cortisol is actually called the stress hormone because it causes the flight-or-fight response and it's basically does a number of things it increases the blood sugars to prepare your body for action it breaks down muscle tissues and when we give it in the form of prednisone it causes a lot of problems one of it of which is weight gain so we know that high cortisol levels can lead to high higher weight gain this is this is independent of the whole insulin pathway but nevertheless since it is a contributor a hormonal contributor to obesity we have to talk about ways that you can reduce cortisol so really a lot a lot of you already kind of have a feeling that stress contributes to weight gain and you all know people and I've known people who got who went under a lot of stress and they gained like 30 pounds and that's really due to the cortisol effect that's not much to do with the insulin effect but there are ways to reduce the cortisol so in this very interesting study I think that was done in University of California San Francisco they took a number of patients and they gave them a number of treatments which were designed to reduce stress so this is yoga meditation group discussions and what you see is that you can actually reduce their cortisol levels which is very important so if you look at the obese patients and what happened to the treatment they reduce their cortisol levels substantially as whereas the patients treated normally had no difference and you could correlate that to the amount of fat reduction so as you your cortisol level starts to go down your abdominal fat level also starts to go down which kind of makes sense so there are ways to reduce the cortisol level which are important so we all think that you know relaxation is natural to us but it actually isn't quite so natural to us there are many many different ways to to reduce stress and it's like anything else it's not just a matter of going to sleep I mean it's something you have to do actively one of the things that has been used for you know thousands of years is meditation and it's really a good way to really calm the mind and it reduces the cortisol levels and so there's there's ways you can do it there's Transcendental Meditation there's different ways you can do it but nevertheless this is something called active relaxation that is it's something you actually have to do to relax it's not something that you're just not doing like I'm you know I'm just going to lie in bed all day kind of thing no that's not what it is it's actually something which you have to practice which you have to learn how to do and it's very easy but it's something you can do every day for 10-15 minutes you may actually feel a lot better too because as you reduce your cortisol levels you are more relaxed as well as you're going to be affecting your weight because you're going to be reducing your cortisol so the basic method of of meditation is basically this you basically get comfortable you try and clear your mind and then you concentrate on either a word or a breathing and just practice body awareness you want to be able to feel your whole body you try and stay in tune with your breathing or that word and if your thoughts stray you kind of try and bring it back around to that and you do that for 10 or 15 minutes every day at first it's very difficult but after a while it gets easier and it's something that you can do you don't have to you know it doesn't depend on the weather you can do it in the comfortable comfort of your own home and actually is very good there's books on it there's videos on how to do it but it is something which is also going to contribute to weight there's other ways you can reduced cortisol there's massage which is a very good method and also yoga all of these methods have been used again for thousands of years and only you know they're basically swift stood the test of time sleeping is the other thing that's very very important because again there's a very strong correlation between sleep deprivation and weight gain so if you look at large studies such as the Nurses Health Study those women who didn't get enough sleep they had a higher risk of weight gain and again if you're not sleeping properly that's going to contribute to your stress levels in this study they looked at sleep deprivation and impaired fasting glucose which is again that insulin resistance and really the first step in developing diabetes you can see that compared to the six to eight hour group those ones who didn't get enough sleep less than six hours a night had a much higher almost a tripling of their rate of impaired fasting glucose and if you take patients and just sleep deprived them so they this is a they took twelve healthy men and they basically put them on sleep deprivation or not and then they measure different things including their hormones what they found is that the sleep deprived group is actually much hungrier and if you look at appetite their appetite is higher so that's nothing to do with the food you eat or anything like that that's simply due to sleep deprivation and the effect of stress so if you look at hunger hormones such as ghrelin that is that is a the higher that hormone is the hungrier you feel it's actually up by 28% just due to the effect of sleep deprivation so leptin is also decreased when you're trying to lose weight it's actually very important to make sure you get enough sleep because again this is a study where they took patients and they cross them over so some of them they would sleep and then after that they would be sleep deprived and some of them went the other way around and what you found was that in terms of weight loss they're pretty equal but if you look at the fat loss it actually is much better if you get enough sleep and in terms of the lean muscle loss again you lose less muscle if you are getting enough sleep so again a few things about sleep I mean it's very important to observe these and this is something called the sleep hygiene which is the area which you sleep has to be you know it needs to be dark you need to be comfortable loose-fitting clothes you need to have regular sleeping hours I mean these are things that you can do medications I don't really think is the answer but it's really important to me get enough sleep because a lot of us are busy and we have other things to do but if you're trying to lose weight you're really going to do yourself a big favor if you get enough sleep so I've put in here so this is how we think about it so I've added the high protein and I've added the cortisol in here and we have the entire metabolic syndrome so the question is in the end what to eat what do we eat in order for us to lose weight well what's kind of replaced the Atkins diet is the Paleolithic diet in terms of popular diets and that's really a diet thing we should just be eating unrefined foods foods as they are found in nature and there really is a lot to be said for that because you know the healthy diet is likely the ones that were adapted to eat that is if you take a cow and you feed it beef it's not going to like it and if you take a lion and you feed a grass it's not going to like it either but it's not that the grass is better for you or the beef is better for you it's the one that you're designed to eat so if there are foods that were designed to eat that should be healthy for us so unrefined foods real foods we should be healthy for us but when once you start getting into the refined foods you know once you start getting into the flowers and the packaged foods and the sugars which are all highly refined that's probably where the the toxicity of the food lies not in the food but in the refining if you look at carbohydrates because carbohydrates get the worst rap of it all if you look at unruhe find carbohydrates vegetables and so on in the primitive man it was all vegetables fruits roots beans none of those are also our our car really bit bad for you but when we talk about carbohydrates now it's all bread and pasta and then the sugars and all of this stuff which is the unrefined carbohydrates which which were never that bad for you in the first place are really a small percentage of what we talked about so a very good book which is this one called the blood sugar solution by dr. Mark Hyman he goes through a number of things and I'll give you a copy of these two to have a look at but they really make a lot of sense and basically it comes down to the fact that you shouldn't be eating a lot of these highly refined food the there are certain foods that are very good to emphasize including a lot of these berries and avocados and nuts and then one that I will touch particularly on is vinegar because very vinegar is a very interesting substance because the major effect of the vinegar is that it improves the insulin sensitivity that is if you take patients and you give them a meal that is bread and you give them bread or bread with vinegar you can measure their glucose how high their sugar goes and you can measure how high their insulin goes and you see that the vinegar has a very good effect to reduce both both the sugar and the this is the sugar and the insulin level and if you have insulin resistance it's even better so this vinegar really acts just like the fiber to reduce your blood glucose spike and reduce your insulin spike so this is something which was quite interesting they actually told these people to take two tablespoons of apple cider vinegar at bedtime and what they did was they measured their blood glucose the next day and you can see that after a few days the fasting blood glucose gets better so this is the people just drinking apple cider vinegar at night if you give them so you just buy it in the supermarket you can buy it any garden I'm not sure about the tablets if they might work the same it's the acid it reduces the yeah it's very good for you and it's good to be put in your foods like the salad dressings and so on a lot of them straight you certainly could but it's kind of sour so it's it's it's probably better to take it in your food yeah and the other thing remember is that the it works to reduce the effect of the other things so if you're taking this this is Brad if you take it with different doses of vinegar you actually get a better and better effect so as you take Brad with more and more vinegar you know like the dip you have oil and vinegar it's going to reduce your serum insulin levels so even the same amount of Brad it depends on what you take it with so the fat will also reduce your your glucose levels but the vinegar has a very good effect to do that as well and the other thing is it tends to make you feel more full again it's thought that the vinegar slows down your gut so that it the blood sugar doesn't go as high the other thing is it takes longer so you actually feel more full again this is they took patients and they gave them Brad or they gave them bread with vinegar and different doses of vinegar so if you take it with just the bread you can see after a number of hours you start to get hungry again because this is the satiety score this is how full you get but you can see that the ones that took it with the vinegar same amount of Brad but they took it with the vinegar actually felt full longer it may make you more full oh you won't only creamy yeah also all types of vinegar they're all acid so it seems that the effect is likely all of them apple cider vinegar red wine vinegar balsamic vinegar and a balsamic sand sometimes have a bit of sugar in it so some of the others might be better and then the the in terms of risk of heart disease what's again very interesting is that if you look at a very large study it might be that the vinegar actually protects your heart too because this is a study where they look if this is the Nurses Health Study and they looked at what people ate and they looked at how much heart disease they got and they said that there's this thing called alpha linolenic acid which is protective alpha linolenic acid is found in both mayonnaise as well as oil and vinegar dressing but if you look at the effect of the mayonnaise mayonnaise has a little bit of a protective effect a little bit okay but look at the oil and vinegar dressing it has the significant protective effect on the incidence of coronary artery disease since they both contain the alpha linolenic acid is certainly possible that it's actually the vinegar which is protecting you and that makes a lot of sense because if the vinegar is reducing your insulin it's going to have the beneficial effects so again these are the protective factors and I've added these ones that you really should think about emphasizing so the fiber is one of the things that we really need to emphasize to really act as an antidote to this insulin but the other thing that's also very beneficial is the vinegar the vinegar as much as you can you should try and add add it the other thing I'm going to just touch on is you know who where are you going to get this information from who are you going to get it from and the thing is that you know a lot of times they say ask your doctor ask your doctor and so the problem is that the doctors usually don't know and I know this very well because I went through medical school I went through training I did all my training I did kidney disease and nutrition impacts really a lot of what I do in fact most of what I do but if you look at the amount of training that I receive it was probably about two or three hours in medical school once I got out into training my internship my residency which was a five year long I don't think I got any training at all and from then on to now there's probably zero amount of training and nutrition so for a fellow who's been practicing medicine for closer to twenty years now I maybe got five hours of instruction back in medicals in the 12 or 13 years I've been in full practice really there's been no talk about nutrition no lectures of nutrition so you think your that your doctor is really up to date on everything your doctor probably doesn't really know in fact I went to a talk recently for after this diabetes forum and you think again that the diabetic doctors oh they're going to be right up to date so I was listening to the talks and there's this fellow he says oh we have this wonderful treatment for hypertension hypercholesterolemia insulin resistance metabolic syndrome anxiety in society is called exercise and that's true certainly true but then he spent the next 59 minutes talking about drugs the very talk after that another nice endocrinologist she said lifestyle changes should be your first second and third choice for diabetes absolutely true she then spent the next 59 minutes out of 60 minutes talking about drugs so the bottom line is that even though they pay lip service to nutrition they really know nothing about it and even what they teach other doctors is all about drugs so a few years ago I went to the McMaster general internal medicine conference four full days of lectures okay so really a great comprehensive review of all kinds of stuff there was one half hour lecture series session devoted to obesity and what they talked about was drugs and surgery what he said was I believe that diet and lifestyle are vital to the treatment of obesity but this lecture will not discuss that topic so four days of lectures and they don't want to talk anything about diet so if you're not going to talk about it in a four day review of everything when are you going to talk about it and the answer really is never so you think your doctor knows but he doesn't know anything what do you do yeah I had to learn it myself so this is what doctors think about obesity this is how they should be treated so or less that is one of the drugs they focused on which actually makes you not absorb the fat and of course what happens is that the fact kind of sneaking out you get this thing called fecal leakage which is about as gross as it sounds you know this is what doctors think about obesity not only that but you get liver kidney toxicity vitamin deficiency this is one of the drugs they're talking about instead of talking about diet so sibutramine which has now been removed from the market because it was increasing heart attacks you had a 20% increase in the rate of heart attacks or stroke this is one of the drugs that they were kept talking to me about or and weight loss surgery so this is the other thing so let's cut out your healthy stomach exactly or we'll cut out you'll put a huge band and so you can't eat this is what doctors think about obesity so just this year actually just a few months ago the New England Journal of Medicine which is really our top journal wrote a little article about obesity and this is what they said well you know we should give people these meals and meal replacement products so meal replacement shakes some pharmaceutical agents can help patients of drugs we should be using drugs so inappropriate patients bariatric surgery so surgery okay so this is what they think about obesity we should be giving people the meal replacement shakes drugs and surgery so that doesn't even make any sense because clearly it's a dietary issue and yet they talk nothing about the diet instead they should be we should be giving people these highly processed meal replacement shakes not only are they slightly gross but they really have are not that good for you and of course the fellow who wrote it so he's paid by the global dairy platform Kraft the knowledge Institute for beer okay this is the guy exactly this is the guy who's writing in the most prestigious journal in medicine okay and he's paid by the knowledge Institute for beer McDonald's Arina pharmaceuticals a drug company novo a diabetes company genomics Jenny Craig Vives all of these things no wonder he's talking to you about this stuff he's just trying to sell drugs give you surgery sell meal replacement shakes have you go to McDonald's drink beer this is the guy you think is teaching other doctors okay that's the really really scary part so instead of getting a guy who is completely unbiased you got this guy who's paid by everybody Under the Sun who cares only about selling product and you think that the Academy of Nutrition and Dietetics would be a good source of information this is the old American Diabetes Association well here's their corporate sponsors again you know Abbott nutrition so they're trying to sell meal replacement shakes coca-cola National Dairy Kellogg's General Mills Mars like Mars bars like really these are the people that are teaching the dietitians what to tell you this is their one of their meetings and you can see coaching your clients towards lasting weight loss brought to you by the coca-cola company one of their messages was that sugar is not harmful to children I mean you only need to ask your mother about that she'll tell you all about that right and the federal nutrition standards for school meals are too restrictive all you have to do is pay right you pay fifty thousand dollars and you can teach the dietitians exactly what they should know and then maybe the American Heart Association is who you should listen to right so you have these health checks turns out all you have to do is pay to get these health checks okay so it's based on certain standards for fats and sodium but there's no consideration of sugars so this is the price right so if you want one to nine products it cost you seven thousand five hundred dollars and this is for if you have more products indoors you get a you know volume discount right it doesn't promote it you yeah this is a company pays the American Heart Association but this for product but you get volume discounts if you put more products on and if you want an exclusive deal you can get an exclusive deal so the Florida citrus grower said ok you will endorse us so you're not going to endorse the other orange juice guy and you get an exclusive deal with the American Heart Association it's all about the dollars and so in 2009 they've since taken this off but Cocoa Puffs and frosted mini-wheats which are just full of sugar they had the health check logo in the United States this is the American Heart Association Heart Walk brought to you by frito-lay and here's Chester the cheetah the cheetah guy right so again you think that the the American Heart Association Canada is any better here's the the Heart and Stroke Foundation logo here on cookies as well as a juice juice which is just full of sugar you think that oh here's the health check logo and it tells you that it's been reviewed by the Heart and Stroke foundations registered dieticians but it's their cookies like really you don't need to be eating cookies and there's no way these cookies are good for you no matter what they are and here they are you think you're doing a good job but you're not you have to know who to trust and the only person you can trust is yourself so these are this is the way we think about the hormonal of BC theory so those are the ways that we can adjust it so really in terms of practical advice these are my last few slides what to eat the main thing to eat is make sure you eat whole unrefined unprocessed foods because the natural foods are going to be the ones that are healthiest for us want to avoid refined carbohydrates you want to find avoid the refined oils which we'll talk about later as well as the process means anything' process is not really good for you avoid the artificial sweeteners they're not they're also like chemicals they're not really good for you and you can eat carbohydrates but you need to make sure they're with packaged with fiber so remember the fiber acts as the antidote so whenever you go and eat unrefined fruits now raw foods carbohydrates always have fiber with them it's the it's the effect of the processing that strips out all the fiber so in a natural state if you eat an apple or if you need a pear or carrot what did it whatever it is if you have carbohydrate you almost always have five or next to it therefore you can't over eat it and again try and stick to the edges of the supermarket then avoid the middle where the highly processed foods we've covered this the last time is when to eat because there's what to eat and then there's when to eat you have to make sure you eat the three meals a day and no snacking remember the snacking is very bad for you because it keeps the insulin levels high and then try to eat all your all your foods within a 8 to 10 hour period if you can so that you have a long period of fasting that is from dinner to breakfast the next day you got 12 hours 14 hours where you have nothing to eat and that restores or helps restore the insulin sensitivity and then the the thing we talked about this time is the cortisol which is a different hormonal pathway but also important in some people in fact in some people it's the major effect but again the key here is sleep but for other things there's also a number of ways that you can reduce your cortisol active relaxation meditation massage okay and I think that's the end any questions okay one of the you know it's it's there that you when when we leave yeah are we supposed to have three meals a day yeah and you know a period of

Channel: Jason Fung

Views: 304,266

Rating: 4.8676767 out of 5

Keywords: obesity, nutrition, education, Insulin, dieting, Weight, Fasting, carbohydrates, Dieting (Symptom), Paleo Diet, Weight Loss, Fat Loss Diet, Atkins, Hormones, Diet (nutrition), health, Diabetes, fat, Medical Education, Diet, Insulin Resistance, Nutrition (Medical Specialty), low-carb, medical, Cure For Diabetes, Calories, Treatment, Weight Management, jasonfung, drjasonfung, fung, drfung, calories explained

Id: ZbnshVO4PRM

Length: 81min 9sec (4869 seconds)

Published: Tue May 14 2013

Reddit Comments

[u/buzzkilll]

Speaking of the Apple Cider Vinegar...I started taking two tbls each night recently and surprisingly, weight started falling off of me rapidly. Glad to see Jason talk about this in the video because anecdotally it seems to be working for me in a big way.

[u/gogge]

Whey protein is highly insulinogenic. But that doesn't matter, insulin isn't what's causing the rise in obesity and diabetes, a high intake of calories (mainly from refined carbs) is what's causing the rise in obesity and diabetes.

Here's a paper discussing insulin resistance with a nice illustration:

Figure 1.

Boden G "Obesity, Insulin Resistance and Free Fatty Acids" Curr Opin Endocrinol Diabetes Obes. 2011 Apr;18(2):139-43. doi: 10.1097/MED.0b013e3283444b09.

More reading on why insulin isn't the issue:

Lyle Mcdonald, "Insulin Levels and Fat Loss".
James Krieger, "Insulin…an Undeserved Bad Reputation".
Stephan Guyenet, "The Carbohydrate Hypothesis of Obesity: a Critical Examination".

Dr. Fung's lectures might be a good starting point for people who want to know more, but a lot of his studies are cherry picked and/or misrepresented to support his "insulin is causing obesity" narrative (which is wrong).

[u/mephistopheles2u]

He also quotes studies on the benefits of apple cider vinegar in reducing insulin levels (somewhere after 1:00:00 mark.

[u/lacker101]

From what I saw in a brief stint of bro-science(Note, not a researcher or student) is dairy does give a slightly higher insulin response... but is still much lower than what you would find on a typical carb diet.

My opinion has always been the easier compliance afforded by diary is greater than the dietary risks it imposes. Especially if you don't have an adverse reaction to it.