Fat Thoughts . . .

As a bariatrician, I think about fat all the time.  I guess you could say I have a lot of "fat thoughts."

I frequently hear patient's tell me, "Dr. Nally, I'm eating RIGHT, but I'm just NOT losing weight!"

If you're not losing weight, your not eating correctly. 99% of your weight loss success is related to your diet. We have been poorly misinformed over last 40 years as to what a "correct" diet contains. We've been told to follow a low fat diet for the last 40-50 years.  However, it is very apparent as patient's follow a low fat diet that only a small percentage of them have success in weight loss, and the majority actually gains more weight and remains significantly hungry.  When you look at the body's physiology, fat restriction only stimulates increased hunger.  The intake of any form of carbohydrate, whether that be simple or complex, stimulates an insulin response.  Based on our genetics, that insulin response can be variable. some of us respond normally and others respond with between 2-10 times the normal insulin surge.  Insulin is actually the hormone that drives weight loss or weight gain.

You and I will not be able to effectively lose weight until we control the response of insulin, and this can only be done through carbohydrate restriction.

The Skinny About Sweeteners

I am often asked about which sweeteners are safe and which ones can be effectively used to assist with weight loss and maintenance.  It has been long in coming, but I finally put it all together in my article "The Skinny About Sweeteners". You can find it at The Arizona Bariatric Institute website under Recommended Links.

Integrated Blog with Website!

After struggling for a few weeks, I figured out how to integrate my blog into my bariatric website.  Just a little reading about "iframes" solved the question and there it is.

The website is a work in progress.  My hope is to help people successfully lose weight and give people an edge up on the dietary treatment of obesity.

Let me know what you think.  I would love to make it a user friendly place for answers.

Age & Weight Gain

I was recently asked why it gets harder to lose weight as you get older.  There are a number of reasons. 

Why the Slowing of the Metabolism ?

First, it is commonly known in the medical community that your metabolism slows by about 5% every ten years after age 30.  This occurs due to intracellular slowing of the mitochondria, the little powerhouses in each cell within your body.  This leads to a significant decrease in the overall fuel you burn on a daily basis and leads to a decreased need for fuel intake over time.  Interestingly, we frequently seem to increase our food intake over time and the sizes of our meals has become larger and larger over the past century.

With Aging We Burn Fewer Calories Each Day -

Second, the average person burns approximately 100 calories less per day for every ten years of age past thirty.  That’s 36,500 calories less each year than in previous years when you and I were younger. The average American gains 1-3% of his or her body weight each year. 

Shifting of Hormones -

Third, there is a hormone shift that occurs with aging as well.  In men, and in some degree in women, testosterone commonly decreases.  This lowering of testosterone leads to decreased stimulus for muscle mass and muscle gain.  We see some natural wasting of muscle tissue as we age.  The muscles are where most of the fuel is burned in the body and it is one of the main locations fat can be metabolized and burned as fuel.  The less muscle you have, the less fat you burn.   

Women also experience a decline in estrogen over time and recent studies show that a decrease in estrogen leads to an increase in retention of abdominal fat.  

Decreased Activity -

Fourth, as we age, we frequently become less active.  This can occur due to the decrease in muscle mass, decrease in bone density and increased fragility of the bones, increased pain due to arthritis and other medical conditions that are age related that make activity a little more difficult.  This overall decrease in activity and lead to weight gain.

How Do I Avoid This?

This is the age old question asked throughout the centuries and the answer to which many have sought for the fountain of youth.  However, what we do know about slowing the slowing is this. 

• Exercise increases the number of mitochondria in our muscles cells.  A healthy well balanced diet will provide the body with adequate protein, amino acids, omega 3 & 6 fatty acids and the essential vitamins and minerals necessary to keep the metabolism operating at its best. 
• A diet low in simple sugars and carbohydrates has been show to decrease free radicals and oxidative stress at the cellular level.  
• Getting adequate sleep is another key.  Sleep gives the body time to repair and restore damaged tissues.  Following up with your doctor to check hormone levels may be needed.  These hormones can often be modified by dietary changes or can be supplemented through medications. 
• Drink adequate water.  Many people’s metabolisms are slowed for the simple reason that they are frequently dehydrated.  Your urine should be the color of tap water. If its any darker, you’re probably not drinking enough water.
• Eat frequent smaller meals 5-6 times per day.  Eating a small meal every 3-4 hours helps your body not to feel like it is starving and it will be less likely to store fat. 

Age will affect us all in the end, but we can age gracefully and slow the process if we apply the simple principles listed above. 

Low Carbohydrate Diets Finding Great Success

Spent part of the morning reviewing 20 years of journal articles on the "Science of Dietary Carbohydrates, Glucose and Insulin."  Fascinating reading. It is interesting that prior to the advent of insulin as a treatment for diabetes, the most common treatment from 1915-1920 used by William Osler for diabetes was significant carbohydrate restriction.

In 1999 a study was published in Pediatrics looking at twelve obese teenage boys.  They were randomly fed low glycemic equal calorie meals followed by high glycemic index meals or vise-versa.  The fascinating result was that when fed following a low glycemic meal, the boys at 81% more if the meal was high in glycemic index.  The fascinating factor is that their insulin levels were much higher which would correlate with notable weight gain and cholesterol rise based on other research.
Another study completed in 2005 helps to quash safety concerns about low carbohydrate diets and shows them to be just as effective in weight loss and more effective in lowering triglycerides, raising HDL in patients with type II diabetes then low fat diets.

My patient's in the office have had tremendous success with low carbohydrate dietary changes over the last 12 months. Every patient in my practice following a very low carbohydrate diet has drastically improved their cardiovascular risk, lipid profile, and significantly reduced their weight. In those patient with type II diabetes, they have additionally had significant improvement in their blood sugar control, average blood sugars (HbA1c) and there triglycerides (on of the lipid measures placing these patients at risk for heart disease). This correlates closely with recent studies reflecting similar results in the medical literature.  It is essential, however, to be monitored regularly on these types of diets, as rapid and significant metabolic changes can and do occur. Medications, blood pressure, and blood sugar control need to be closely monitored when following a low carbohydrate diet. Close follow up with your physician is highly recommended.

Waist Size in Childhood Predicts Risk for Adult Metabolic Syndrome

A recent study published in the Journal of Obesity begun in 1985 shows that your waist size as a child is a very strong and independent risk factor in your forming metabolic syndrome later in life.  Metabolic syndrome is a precursor stage to type II diabetes mellitus that puts you at significant risk for heart disease and stroke. The study was conducted in 2188 boys and these boys were followed and evaluated at age seven, fifteen, and twenty-seven years old (twenty years later).
Results show that as your waist circumference increases as a child, your risk for metabolic syndrome notably increases and is unrelated to waist changes between childhood and adulthood.  This means that emphasis on childhood weight is significant and must be a factor in evaluation of the child's overall health and risk for disease later in life.

Resistance Training More Effective in Shrinking Your Middle!

Resistance training with dietary changes were found to reduce abdominal adiposity (apple type weight gain) better that dietary changes alone in a recent study published in The International Journal of Obesity.

HCG & Weight Loss Fads

A number of patient have heard and asked me about Human Chorionic Gonadotropin (HCG). It is a hormone normally secreted by the trophoblastic cells of the placenta during pregnancy. It was first described as a treatment for obesity in conjunction with a very low calorie diet by Dr. A. Simeons in 1954.  Dr. Simeons reported weight loss success combining HCG with a very low calorie diet.  Multiple subsequent studies revealed that this method has been ineffective and that there has been no significant effect of HCG over placebo.  It appears that the weight loss occuring in these patients was due to the very low calorie diet used at the time and not the HCG; however, it has also since been shown that the diet used by Dr. Simeons was deficient in protein content based on current standards accepted in the bariatric (weight and metabolism specialist) community. 

The American Society of Bariatric Physicians released a position statement on HCG including the following summary and conclusions:
"Numerous clinical trials have shown HCG to be ineffectual in producing weight loss. HCG injections can induce a slight increase in muscle mass in androgen-deficient males. The diet used in the Simeons method provides a lower protein intake than is advisable in view of current knowledge and practice. There are few medical literature reports favorable to the Simeons method; the overwhelming majority of medical reports are critical of it. . .
Conclusions:
It is the position of the American Society of Bariatric Physicians that:
1. The Simeons method for weight loss is not recommended.
2. The Simeons diet is not recommended.
3. The use of HCG for weight loss is not recommended."
(http://www.asbp.org/resources/uploads/files/HCG%20Position%20Statement.pdf)

It is important that you consult your doctor before you begin any weight loss program and that you are aware of the recent data on current fads like the use of injectible and subligual HCG.

Dr. Nally is a member of the American Society of Bariatric Physicans and adheres to the metabolic and weight managment guidelines set forth by this medical society.