With the U.S. government unwilling to impose mandates on obesity – which is implicated in the deaths of more than four times as many Americans as COVID-19 over the course of the past decade, if you believe the studies – it might be a good time to talk about a new and raging medical debate over what is fueling the country’s most visibly obvious epidemic.
And, no, we’re not talking about genes.
When it comes to body fat, some people might be more genetically inclined than others to pile on the blubber, but as Harvard University scientists studying obesity have noted “Genes Are Not Destiny.”
There have been genes linked to the tendency to add body fat, but as they write, “‘many people who carry these so-called ‘obesity genes’ do not become overweight, and healthy lifestyles can counteract these genetic effects.”
Or maybe not.
Dr. David Ludwig, an endocrinologist and researcher at Boston Children’s Hospital and professor of pediatrics and nutrition at Harvard, has made a strong case for the problem being what we eat – not necessarily how much we eat or how much we exercise – that has kicked off something of a scientific firestorm.
“Obesity Paper Has Diet Researchers Riled Up” is how the website MedPage Today headlined the situation on Tuesday in what it billed as an “exclusive” and “special report.”
The dietary hypothesis posted last month in The American Journal of Clinical Nutrition by Ludwig and a team of more than a dozen researchers from Cornell Medicine, the Univesity of Copenhagen, the National Institute on Aging, the University of British Columbia, the University of California’s Berkley and San Fransicso campuses, Harvard, Ohio State University, Duke University, Boston Children’s Hospital and a variety of research institutes is not exactly new.
But the credentials of the scientists now embracing the carbohydrate-insulin conundrum seem to have given it new weight.
The piece “stirred up tensions in the worlds of epidemiology, physiology, and nutrition,” wrote Sophie Putka at MedPage. “Doctors and researchers argued on Twitter; (and) commenters defended and derided related opinion pieces.”
What the Ludwig-led commentary did was question the simple, long-held and fundamental belief that obesity is merely about calories consumed and calories expended or what scientists call “the energy balance model (EBM).”
While the authors of the paper did not disagree with that model as a fundamental reality, they argued that it errors by merely restating “a principle of physics without considering the biological mechanisms that promote weight gain.”
There is really no denying the energy balance model. People who are placed on starvation diets or go on hunger strikes lose weight. None of them stay fat. It just doesn’t happen.
But few people in this country or elsewhere are put on starvation diets, and it takes amazing willpower to maintain a hunger strike, which makes energy balance much more complicated in the real world than in a theoretically simplified world.
In the real world, Ludwig and others argue, obesity is complicated by a diet now rich in carbohydrates and the response of the human body to this diet.
“Rapidly digestible carbohydrates, acting through insulin and other hormones, cause increased fat deposition, and thereby drive a positive energy balance,” they write.
Among those living the now-common “sedentary lifestyle,” a “positive energy balance” is not a positive. A positive energy balance leads your body to store fat in the interest of self-preservation for future periods when food supplies might be limited.
For most of human history – no matter whether you were a Neanderthal living in a European cave 100,000 years ago, a Dorset Eskimo living along the Arctic Coast 2,500 years ago, or an Athabascan Indian or gold prospector in Alaska only a century ago – this was a good thing.
Some body fat could help you get through those times when there was little or no food to be had. Now, however, with food readily available, the same accumulation of fat has become a liability.
It has been linked to heart disease, stroke, diabetes, some cancers, gallbladder disease and, lately, COVID-19, the disease caused by the pandemic SARS-CoV-2 virus.
A peer-reviewed study published at PLOS One on Tuesday reported that in the first wave of the pandemic in Sweden the obese were about twice as likely as their thinner countrymen to end up dead or with a prolonged length of stay (LOS) in an intensive care unit.
“A prolonged LOS reflects a more severe course of disease and is associated with greater functional impairment in survivors.,” they added…;”A prolonged LOS is an important factor not only for the individual patient but also as an important factor for health care, putting excess strain on ICUs during the COVID-19 outbreak.”
Obesity, once a human luxury, has become a curse in much of the modern world.
But Ludwig and his colleagues argue it’s not really our fault.
Well, sort of.
They argue a carbohydrate-insulin model (CIM) has us trapped in a nasty feedback loop.
Basically, the theory is that when we eat foods with a high “glycemic load” – breads, pastries, potatoes, french fries, crackers, chips, etc. – we quickly convert them to body fat and having done so quickly grow hungry again.
Or to quote the study:
“Three hours after eating, most of the nutrients from a high-GL meal have been absorbed from the digestive tract. However, the persistent anabolic actions from this hormonal response slow the shift from uptake to release of glucose in liver and fatty acids in adipocytes.
“Consequently, total metabolic fuel concentration in the blood (from glucose, nonesterified fatty acids, and ketones) decreases rapidly in the late postprandial phase, possibly to concentrations below that in the fasting state.
“The brain perceives this signal as indicating that critical tissues (e.g., liver) are deprived of energy – a state of ‘cellular semistarvation’ as it has been termed – and may respond to the metabolic challenge with a counter-regulatory hormone response.
“Simultaneously, hunger and cravings for high-GL foods (i.e., those that rapidly raise blood glucose) increase, setting the stage for a vicious cycle.”
Probably the most controversial part of this view is that it suggests the low-fat diet craze has made the obesity problem worse rather than better through the years, although they do admit they could be wrong.
“In this review, we provide the most comprehensive formulation of the CIM to date, argue that the CIM better reflects knowledge on the biology of body weight control than the EBM, specify testable hypotheses to help resolve controversies, and call for constructive discourse among scientific camps on this question of critical public health importance,” they write.
It’s hard to disagree with that.
Full disclosure: The author of this story generally believes in the energy-balance model. Like most Americans, he has also struggled with weight. He has never seriously experimented with the carbohydrate-insulin model.
But a fishing buddy, who shall remain nameless, resorted to it years ago. It always seemed sort of silly when he visited a restaurant for lunch or dinner (back in the good old days when restaurant dining was safe), and ordered a hamburger sans bun and a salad instead of fries.
He’d generally sworn off bread and potatoes as having too high of a glycemic index. This form of dieting worked for him. He managed to get back to his old high-school weight years ago and has stayed there now since, which is no small accomplishment for a man in his 60s.
If only we could all claim the same.
Categories: Commentary, News
I see value in both approaches. But what really got me is the picture of the undulating fat with the face on it!! Hard to look away….
There are a lot of issues at play here. First and foremost, our society has failed a couple of generations by not promoting, when young, a healthy lifestyle and fitness for life for all. One would think, it would be advantageous, just in theory, to have a healthy work force and a pool of candidates to defend the homeland. After age 21, the information is there, but once overweight and out of condition , an individual faces a ton of roadblocks, even assuming no bad luck ( genetics, accidents, & disease). Working for a living is not conducive to that energy/balance model.
Training the body for life long performance is a lifestyle choice and one of priorities. The problem for adults is mostly psychological, and an argument could be made that performance is 99% mental (this is based on personal experience and observation). It is easier to adapt to a sedentary lifestyle and poor diet, than it is to adapt to what can be called an ‘active/fit’ one. The solution is to figure it out, then stay active and have fun.
What we need is an Alaskan salmon mandate. Everyone must eat our salmon or they lose there job. It is for your health. Get The CDC director and whitehouse pandemic director stock in Alaskan fish companies.
Glad to see Medred has latched on to a new *thing*. Now, if he can just find a way to incorporate pink salmon into the *thing*.
Low carb / high proteins has always worked for me because once I’m 3 or 4 days into it, the hunger and cravings go way down. I stop thinking about food. I eat less.
My issue is that once I have my weight back to where it should be, it is so easy to slide back into the carbs. They are everywhere and they do taste good. It doesn’t take much to bring my body back into the carb cycle with all its cravings.
I make sure to weigh myself every morning. When I see 5 or 10 to many pounds, it motivates me to do what I know works. It is a bit of a yo-yo, but it is still healthier than letting myself go to 30 or 40 pounds over.
Everybody has to find the formula that works for them.
My wife loves to cook pasta, rice, potatoes and pies. She hates it when I declare I need to get back on the low carb thing. Ones social situation does play into this.
Still wearing the same size jeans that I worn my senior year in H.S.
As I approach 47 this winter, I can see that maintaining your ideal weight is one of the best things that you can do for your health.
I used to eat a lot of protein during my younger years as I was always focused on strength & recovery from long days of hiking & climbing in the hills.
The last few years I have moved to a 100% plant based diet that focuses on fiber more than protein.
Starting the day with fruit and slowly working into vegetables and grains throughout the afternoon seems to work best for me.
Refined Sugars, Caffeine & Alcohol has all been removed from my diet.
Pasta & white flour is also a waste of calories & does more harm to your gut biome than good.
The plandemic has brought two major problems front & center to our society.
First is that there are way too many fat people in America that are a burden to the system & themselves.
Second is that we are WAY less of a Republic / Democracy than we all thought.
Our politicians are bought and paid for by Big Pharma & other corporate interests that have connections to trans-national alliances like the World Economic Forum & Bilderberg Group…these international groups are pushing a new form of Techno-Fascism on the world and unless we fight back and refuse their mandates, all that our families have built here over generations will be lost.
It is no mistake that obesity in the US really took off in the mid-1960s after the FDA adopted the carb-rich food pyramid as the model. Recent mods of it are slightly better, but still carb-rich.
For those of us in the lo carb world (that seems to work well enough for this recovering fat man to keep doing it), the only numbers you need to know are carbs and fiber. Subtract fiber from carbs to get effective carbs per serving. The only higher math you need to do are alcohol based sugars which are metabolized differently. Cheers –
This piece contains a very good explanation for why a person who has a high carb / sugar diet has a regular “sinking spell” shortly after eating. And why the same people feel so hungry so soon after eating. It truly is a cycle that is hard to break.
It is something like an addiction. . But personal experience and many experts have led me to conclude that if your diet is changed to a protein/fat intake with hardly any sugars or carbs, that in approx 5 days the sugar / carb craving goes away. And the weight comes off pretty fast at first, but is dependent in you not slipping back to your previous ways. Once you slip back it is often with a vengeance and with a binge of sweets and carbs. And “the beat goes on”.
I blame agriculture and a climate controlled built environment. Our lean hunter-gatherer ancestors were not lounging on the couch in their underwear in the middle of an Alaskan winter sucking on corn syrup.